Omrani Osama, O'Connor Jody, Hartley John, James Greg
Department of Neurosurgery, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK.
Barts and the London School of Medicine and Dentistry, London, UK.
Childs Nerv Syst. 2018 Dec;34(12):2407-2414. doi: 10.1007/s00381-018-3953-0. Epub 2018 Aug 21.
Shunt infection is a major problem in paediatric neurosurgery. Our institution introduced a mandatory shunt protocol with the aim of reducing infection rate.
A retrospective cohort study including consecutive patients undergoing permanent shunt operations (primary insertion and revision) across two study periods: 3 years immediately prior (2009-2012) and 3 years immediately after (2012-2015) protocol introduction. Absolute and relative risk reductions (ARR/RRR) and Chi-square statistical analysis was used alongside logistic regression, where any single factor with p ≤ 0.20 included in the multivariate model, producing an odds ratio (OR).
Eight hundred nine operations in 504 children were identified (442 pre-protocol, 367 post). Overall infection rate decreased from 5.43% (24/442) pre-protocol to 3.27% (12/367) post-protocol (ARR = 2.16%, RRR = 39.8%, NNT = 46.3, p = 0.138), which did not reach statistical significance. For primary shunt insertions, infection rate reduced from 3.63 to 2.55% (ARR = 1.08%, RRR = 29.8%, NNT = 92.6, p = 0.565), whilst for revisions, it reduced from 6.83 to 3.81% (ARR = 3.02%, RRR 44.2%, NNT = 33.1, p = 0.156). Multivariate logistic regression showed that surgeon experience was a statistically significant predictor of infection, whilst responsible pathogens and latency were similar across the pre- and post-protocol groups.
The protocol reduced overall infection rate in primary and revision shunt operations and we recommend paediatric units consider introducing a similar protocol for these procedures.
分流感染是小儿神经外科的一个主要问题。我们机构引入了一项强制性分流方案，旨在降低感染率。
一项回顾性队列研究，纳入了两个研究期间连续接受永久性分流手术（初次植入和翻修）的患者：方案引入前3年（2009 - 2012年）和方案引入后3年（2012 - 2015年）。使用绝对和相对风险降低率（ARR/RRR）以及卡方统计分析，并结合逻辑回归，将多变量模型中p≤0.20的任何单一因素纳入，得出比值比（OR）。
共确定了504名儿童的809例手术（方案实施前442例，方案实施后367例）。总体感染率从方案实施前的5.43%（24/442）降至方案实施后的3.27%（12/367）（ARR = 2.16%，RRR = 39.8%，NNT = 46.3，p = 0.138），未达到统计学意义。对于初次分流植入，感染率从3.63%降至2.55%（ARR = 1.08%，RRR = 29.8%，NNT = 92.6，p = 0.565），而对于翻修手术，感染率从6.83%降至3.81%（ARR = 3.02%，RRR = 44.2%，NNT = 33.1，p = 0.156）。多变量逻辑回归显示，外科医生经验是感染的统计学显著预测因素，而方案实施前后两组的致病病原体和潜伏期相似。
该方案降低了初次和翻修分流手术的总体感染率，我们建议儿科单位考虑为这些手术引入类似方案。
