• Garrett T Venable, Pooja Dave, William E Gordon, Brittany D Fraser, David A Wallace, William Mangham, Douglas R Taylor, Nickalus R Khan, L Madison Michael, Brandy N Vaughn, and Paul Klimo.
• Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
• World Neurosurg. 2020 Feb 1; 134: e815-e821.

BackgroundThe preventable shunt revision rate (PSRR) was recently introduced in pediatric hydrocephalus as a quality metric for shunt surgery. We evaluated the PSRR in an adult hydrocephalus population.MethodsAll ventricular shunt operations (January 1, 2013 to March 31, 2018) performed at a university-based teaching hospital were included. For any index surgery (de novo or revision) resulting in reoperation within 90 days, the index surgery details were collected, and a consensus decision was reached regarding whether the failure had been potentially avoidable. Preventable failure was defined as failure due to infection, malposition, disconnection, migration, or kinking. The 90-day shunt failure rate and PSRR were calculated. Bivariate analyses were performed to evaluate the individual effects of each independent variable on preventable shunt failure.ResultsA total of 318 shunt operations had been performed in 245 patients. Most patients were women (62%), with a median age of 48.2 years (interquartile range, 31.2-63.2 years). Most had had ventriculoperitoneal shunts placed (86.5%), and just more than one half were new shunts (51.6%). A total of 53 cases (16.7%) in 42 patients experienced shunt failure within 90 days of the index operation. Of these, 27 failures (8.5% of the total cases; 51% of the failures) were considered potentially preventable. The most common reasons were infection (37%; n = 10) and malposition of the proximal and distal catheters (both 25.9%; n = 7). Age was the only statistically significant difference between the 2 groups, with the patients experiencing preventable shunt failure older than those without preventable shunt failure (51.4 vs. 37.1 years; P = 0.017).ConclusionsThe 90-day PSRR can be applied to an adult population and serve as a quality metric.Copyright © 2019 Elsevier Inc. All rights reserved.

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