Cochrane D D, Kestle J
Department of Surgery, University of British Columbia and Children's and Women's Health Center of British Columbia, Vancouver BC, Canada.
Eur J Pediatr Surg. 2002 Dec;12 Suppl 1:S6-11. doi: 10.1055/s-2002-36864.
Ventricular shunting remains the principle and most generally applicable method to treat hydrocephalus in children. This paper describes the demographics of this treatment in English Canada during the period of 1989 to March 2001.
Hospital discharge records were obtained for patients less than 18 years who had a shunt inserted or revised. A database was constructed relating patients and procedures to hospital discharges based on scrambled patient identifiers, year of birth, sex, postal code and diagnoses.
5,947 patients underwent ventricular shunting procedures for hydrocephalus in this period. 261 surgeons working in 73 institutions provided 12,106 interventions (Shunt insertions: ventriculoperitoneal--5009, ventriculoatrial--119, ventriculopleural--28. Revisions: 6,950). Infection was deemed to have occurred in 1,059 procedures. Over the study period, the median number of procedures performed per surgeon per year was 2, with 75 % of surgeons performing 5 or fewer procedures in children per year. Although many surgeons operated on children throughout the thirteen years of the study, many did not acquire substantive cumulative experience. Overall infection rate was 8.6 %. Surgeon infection rates were greater than or equal to 20 % during the first four years of practice and thereafter they fell to and remained in the 10 % range. The mean shunt survival at 12 months of individual surgeons varied between 50 - 60 %, regardless of the number of years of experience of the surgeon; however, performance variability as measured by the standard deviation of 12 month survival rates for all surgeons, adjusted for years of experience, ranged widely until the fifth year of practice. The average number of procedures per year for treating hospitals was 2 with 75 %, providing 12 or fewer services annually. Over the entire study, 50 % of institutions provided 10 or fewer procedures. The mean institutional infection rate was 11.4 % (SD 23, median--6.0).
Quality monitoring of infection rate and duration of shunt function remains critical as many surgeons and hospitals provide care to children with hydrocephalus infrequently. Variability in infection rates and shunt survival at 12 months are a function of surgeon experience, measured by years in practice. Variability in outcome decreases with increasing surgeon experience.
脑室分流术仍是治疗儿童脑积水的主要且最普遍适用的方法。本文描述了1989年至2001年3月期间加拿大英语区这一治疗方法的相关数据。
获取了年龄小于18岁且接受分流管植入或修订手术患者的医院出院记录。基于打乱的患者标识符、出生年份、性别、邮政编码和诊断信息,构建了一个将患者、手术与医院出院情况相关联的数据库。
在此期间,5947例患者接受了脑积水脑室分流手术。73家机构的261名外科医生进行了12106次干预(分流管植入:脑室 - 腹腔分流术5009例、脑室 - 心房分流术119例、脑室 - 胸腔分流术28例。修订手术:6950例)。1059例手术被认为发生了感染。在研究期间,每位外科医生每年进行手术的中位数为2例,75%的外科医生每年为儿童进行5例或更少的手术。尽管在研究的13年中许多外科医生都为儿童做手术,但许多医生并未积累大量的累积经验。总体感染率为8.6%。外科医生在执业的前四年感染率大于或等于20%,此后降至并保持在10%的范围。无论外科医生的经验年限如何,个体外科医生12个月时的分流管平均生存率在50% - 60%之间;然而,根据经验年限调整后,所有外科医生12个月生存率的标准差所衡量的手术效果变异性,在执业的第五年之前差异很大。治疗医院每年的平均手术例数为2例,75%的医院每年提供12例或更少的服务。在整个研究中,50%的机构进行了10例或更少的手术。机构平均感染率为11.4%(标准差23,中位数 - 6.0)。
由于许多外科医生和医院很少为脑积水儿童提供治疗,因此对感染率和分流管功能持续时间进行质量监测仍然至关重要。感染率和12个月时分流管生存率的变异性是外科医生经验(以执业年限衡量)的函数。随着外科医生经验的增加,结果变异性降低。