Menger Richard P, Connor David E, Thakur Jai Deep, Sonig Ashish, Smith Elainea, Guthikonda Bharat, Nanda Anil
Department of Neurosurgery, Louisiana State University of Health Sciences; and.
Neurosurg Focus. 2014 Nov;37(5):E4. doi: 10.3171/2014.8.FOCUS14436.
OBJECT: Complications following lumboperitoneal (LP) shunting have been reported in 18% to 85% of cases. The need for multiple revision surgeries, development of iatrogenic Chiari malformation, and frequent wound complications have prompted many to abandon this procedure altogether for the treatment of idiopathic benign intracranial hypertension (pseudotumor cerebri), in favor of ventriculoperitoneal (VP) shunting. A direct comparison of the complication rates and health care charges between first-choice LP versus VP shunting is presented. METHODS: The Nationwide Inpatient Sample database was queried for all patients with the diagnosis of benign intracranial hypertension (International Classification of Diseases, Ninth Revision, code 348.2) from 2005 to 2009. These data were stratified by operative intervention, with demographic and hospitalization charge data generated for each. RESULTS: A weighted sample of 4480 patients was identified as having the diagnosis of idiopathic intracranial hypertension (IIH), with 2505 undergoing first-time VP shunt placement and 1754 undergoing initial LP shunt placement. Revision surgery occurred in 3.9% of admissions (n = 98) for VP shunts and in 7.0% of admissions (n = 123) for LP shunts (p < 0.0001). Ventriculoperitoneal shunts were placed at teaching institutions in 83.8% of cases, compared with only 77.3% of first-time LP shunts (p < 0.0001). Mean hospital length of stay (LOS) significantly differed between primary VP (3 days) and primary LP shunt procedures (4 days, p < 0.0001). The summed charges for the revisions of 92 VP shunts ($3,453,956) and those of the 6 VP shunt removals ($272,484) totaled $3,726,352 over 5 years for the study population. The summed charges for revision of 70 LP shunts ($2,229,430) and those of the 53 LP shunt removals ($3,125,569) totaled $5,408,679 over 5 years for the study population. CONCLUSIONS: The presented results appear to call into question the selection of LP shunt placement as primary treatment for IIH, as this procedure is associated with a significantly greater likelihood of need for shunt revision, increased LOS, and greater overall charges to the health care system.
目的：据报道，腰大池腹腔（LP）分流术后并发症发生率在18%至85%之间。由于需要多次翻修手术、医源性Chiari畸形的发生以及频繁的伤口并发症，许多人已完全放弃该手术来治疗特发性良性颅内高压（假性脑瘤），转而青睐脑室腹腔（VP）分流术。本文对首选LP分流术与VP分流术的并发症发生率和医疗费用进行了直接比较。 方法：查询2005年至2009年全国住院患者样本数据库中所有诊断为良性颅内高压（国际疾病分类第九版，代码348.2）的患者。这些数据按手术干预进行分层，并生成了各自的人口统计学和住院费用数据。 结果：加权样本中有4480名患者被诊断为特发性颅内高压（IIH），其中2505例行首次VP分流术，1754例行首次LP分流术。VP分流术入院患者中有3.9%（n = 98）进行了翻修手术，LP分流术入院患者中有7.0%（n = 123）进行了翻修手术（p < 0.0001）。83.8%的VP分流术在教学机构进行，而首次LP分流术仅为77.3%（p < 0.0001）。初次VP分流术（3天）和初次LP分流术的平均住院时间（LOS）有显著差异（4天，p < 0.0001）。研究人群中，92例VP分流术翻修费用（3453956美元）和6例VP分流术移除费用（272484美元）在5年内总计3726352美元。研究人群中，70例LP分流术翻修费用（2229430美元）和53例LP分流术移除费用（3125569美元）在5年内总计5408679美元。 结论：本文结果似乎对选择LP分流术作为IIH的主要治疗方法提出了质疑，因为该手术与分流术翻修的可能性显著增加、住院时间延长以及医疗系统的总体费用增加有关。
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