Postoperative cerebrospinal fluid wound leakage as a predictor of shunt infection: a prospective analysis of 205 cases. Clinical article.

OBJECT

The purpose of this study was to audit some of the risk factors for CSF shunt infections within the authors' practice and analyze the statistical significance of these factors.

METHODS

The authors used their own contemporaneously collected shunt database in this study. All shunt procedures performed over a 2-year period between March 2000 and February 2002 at Great Ormond Street Hospital, London, were analyzed. For the purposes of this study, positive CSF cultures were a prerequisite for a data set to qualify as a shunt infection. The authors studied the effects of patient age, the etiology of hydrocephalus, whether the surgery was primary shunt placement versus a revision, the surgeon's level of experience, whether the surgery was performed on an elective or emergency basis, and the presence or absence of a perioperative CSF leak. Statistical analyses were performed.

RESULTS

Two hundred and five patients with a mean (+/- SD) age at surgery of 27.9 +/- 43.0 months were included in this study. Shunt infections developed in 17 patients (8.3%) at a median of 42 days postoperatively (range 14-224 days). The presence of a perioperative CSF leak was the only variable that showed a statistically significant association with the occurrence of a shunt infection, with an infection rate of 57.1% compared to 4.7% in cases with no leak (OR 27.0 [95% CI 7.7-94.3]). The cause of hydrocephalus, elective versus emergency surgery, level of surgeon experience, a primary versus a revision procedure, and patient age did not have a bearing on the infection risk.

CONCLUSIONS

The presence of a perioperative CSF leak puts pediatric patients at a very high risk of shunt infection. Aside from prevention, the optimal management of such CSF leaks require further investigation.