Miyata Shin, Golden Jamie, Lebedevskiy Olga, Stein James E, Bliss David W
Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
, 23415 S Vermont Ave, Unit C, Torrance, CA, 90502, USA.
Pediatr Surg Int. 2017 Nov;33(11):1221-1230. doi: 10.1007/s00383-017-4167-3. Epub 2017 Sep 30.
To evaluate whether simultaneous abdominal surgery or wound contamination at the time of ventriculoperitoneal (VP) shunt placement are associated with increased shunt complications.
Pediatric patients who underwent VP shunt placement were identified using the National Surgical Quality Improvement Program Pediatric database. VP shunt complication rates were compared between patients who underwent simultaneous abdominal surgeries at the time of VP shunt placement vs those who did not and between those with clean/clean-contaminated and contaminated/dirty wound classifications. Adjusted analysis was performed using 1:5 case-control matching.
Among 2715 patients who underwent VP shunt placement, 21 had simultaneous abdominal procedures and were matched with 105 control patients. No significant difference was found in overall (34.3 vs 14.3%, p = 0.07), infectious (8.6 vs 4.8%, p = 1.000), or non-infectious (25.7 vs 9.5%, p = 0.156) shunt complications in the simultaneous vs non-simultaneous group, respectively. In a separate analysis of wound classification, 12 patients with contaminated/dirty wounds were matched with 60 patients with clean/clean-contaminated wounds. The rates of shunt infections for clean/clean-contaminated and contaminated/dirty cases were 10.0 and 16.7%, respectively (p = 0.613).
In our matched case-control study, neither simultaneous abdominal surgery nor wound contamination at the time of VP shunt placement demonstrated significant increased risk of 30-day post-operative complication.
评估在脑室腹腔（VP）分流术置入时同时进行腹部手术或伤口污染是否与分流并发症增加相关。
使用国家外科质量改进计划儿科数据库识别接受VP分流术置入的儿科患者。比较在VP分流术置入时同时进行腹部手术的患者与未进行同时腹部手术的患者之间以及伤口分类为清洁/清洁-污染和污染/脏污的患者之间的VP分流并发症发生率。采用1:5病例对照匹配进行调整分析。
在2715例接受VP分流术置入的患者中，21例同时进行了腹部手术，并与105例对照患者匹配。同时手术组与非同时手术组在总体（34.3%对14.3%，p = 0.07）、感染性（8.6%对4.8%，p = 1.000）或非感染性（25.7%对9.5%，p = 0.156）分流并发症方面均未发现显著差异。在伤口分类的单独分析中，12例伤口污染/脏污的患者与60例伤口清洁/清洁-污染的患者匹配。清洁/清洁-污染和污染/脏污病例的分流感染率分别为10.0%和16.7%（p = 0.613）。
在我们的匹配病例对照研究中，VP分流术置入时同时进行腹部手术或伤口污染均未显示术后30天并发症风险显著增加。
