Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
Neurosurgery. 2018 Sep 1;83(3):480-487. doi: 10.1093/neuros/nyx440.
Pediatric hydrocephalus represents a high health care burden in the United States (US). Surgery is the mainstay of treatment.
To perform a comparative effectiveness analysis for endoscopic third ventriculostomy (ETV) and cerebrospinal fluid shunt placement in pediatric hydrocephalus patients in the US using a large administrative claims database through the application of propensity scores matching.
The MarketScan® database (Truven Health Analytics, Atlanta, Georgia) 2003 to 2011 was used. Patients 19 yr or younger at first occurrence of ETV or shunt during the study period were included. The study outcome, surgery failure, was defined as further surgical treatment for hydrocephalus subsequent to initial ETV or shunt procedure. Age, etiology of hydrocephalus, and history of shunt were used to create matched samples for the ETV and shunt cohorts. Kaplan-Meier survival curves, stratified log-rank test, and Cox proportional-hazard models were used to analyze samples.
There were 3231 eligible cases (478 ETV; 2753 shunt). Propensity scores matching produced 455 balanced pairs. For matched samples, 326 of 455 (72%) pairs were concordant, while 129 pairs were discordant in surgery outcomes within 3 mo. Among discordant pairs, ETV patients were more likely to experience surgery failure compared to patients receiving shunt (relative risk = 1.4, P value = .011). Furthermore, patients' age < 1 yr had lower ETV success rates than those with shunt (P value = .009). No similar pattern was found in patients' age ≥ 1 yr.
There was no significant effect on time to failure between patients undergoing ETV and shunt, except in infants' age <1 yr.
小儿脑积水在美国（美国）是一个很高的医疗保健负担。手术是治疗的主要方法。
通过应用倾向评分匹配，使用大型行政索赔数据库对美国小儿脑积水患者行内镜第三脑室造瘘术（ETV）和脑脊液分流术的比较效果进行分析。
使用 MarketScan®数据库（Truven Health Analytics，亚特兰大，佐治亚州）2003 年至 2011 年的数据。在研究期间，将首次出现 ETV 或分流术的 19 岁或以下的患者纳入研究。研究结果为手术失败，定义为初次 ETV 或分流术后续对脑积水进行进一步手术治疗。使用年龄、脑积水病因和分流术史为 ETV 和分流术队列创建匹配样本。使用 Kaplan-Meier 生存曲线、分层对数秩检验和 Cox 比例风险模型对样本进行分析。
有 3231 例符合条件的病例（478 例 ETV；2753 例分流术）。倾向评分匹配产生了 455 对平衡样本。对于匹配样本，326 对（72%）的样本在 3 个月内的手术结果一致，而 129 对的样本不一致。在不一致的对中，与接受分流术的患者相比，接受 ETV 的患者更有可能出现手术失败（相对风险=1.4，P 值=0.011）。此外，年龄<1 岁的患者 ETV 成功率低于分流术患者（P 值=0.009）。在年龄≥1 岁的患者中没有发现类似的模式。
在年龄<1 岁的婴儿中，除了年龄<1 岁的婴儿外，行 ETV 和分流术的患者之间的失败时间没有显著差异。
