LeHanka Allison, Piatt Joseph
1University of Notre Dame, Notre Dame, Indiana.
2Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; and.
J Neurosurg. 2020 May 29;134(3):1210-1217. doi: 10.3171/2020.3.JNS20528. Print 2021 Mar 1.
Hydrocephalus is a common, chronic illness that generally requires lifelong, longitudinal, neurosurgical care. Except at select research centers, surgical outcomes in the United States have not been well documented. Comparative outcomes across the spectrum of age have not been studied.
Data were derived for the year 2015 from the Nationwide Readmissions Database, a product of the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. In this data set patients are assigned state-specific codes that link repeated discharges through the calendar year. Discharges with diagnostic codes for hydrocephalus were extracted, and for each patient the first discharge defined the index admission. The study event was readmission. Observations were censored at the end of the year. In a similar fashion the first definitive surgical procedure for hydrocephalus was defined as the index operation, and the study event was reoperation for hydrocephalus or complications. Survival without readmission and survival without reoperation were analyzed using life tables and Kaplan-Meier plots.
Readmission rates at 30 days ranged between 15.6% and 16.8% by age group without significant differences. After the index admission the first readmission alone generated estimated hospital charges of $2.25 billion nationwide. Reoperation rates at 30 days were 34.9% for infants, 39.2% for children, 47.4% for adults, and 32.4% for elders. These differences were highly significant. More than 3 times as many index operations were captured for adults and elders as for infants and children. Estimated 1-year reoperation rates were 74.2% for shunt insertion, 63.9% for shunt revision, but only 34.5% for endoscopic third ventriculostomy. Univariate associations with survival without readmission and survival without reoperation are presented.
In the United States hydrocephalus is predominantly a disease of adults. Surgical outcomes in this population-based study were substantially worse than outcomes reported from research centers. High reoperation rates after CSF shunt surgery accounted for this discrepancy.
脑积水是一种常见的慢性疾病，通常需要终身的、长期的神经外科护理。除了在特定的研究中心外，美国的手术结果尚未得到充分记录。尚未对不同年龄段的比较结果进行研究。
数据来源于2015年的全国再入院数据库，这是医疗保健研究与质量局医疗保健成本和利用项目的一个成果。在这个数据集中，患者被分配特定州的代码，通过日历年将重复出院联系起来。提取有脑积水诊断代码的出院记录，对于每位患者，第一次出院定义为索引入院。研究事件为再入院。观察在年底进行截尾。以类似方式，脑积水的第一次确定性外科手术定义为索引手术，研究事件为脑积水或并发症的再次手术。使用生命表和Kaplan-Meier图分析无再入院生存和无再次手术生存情况。
按年龄组划分，30天再入院率在15.6%至16.8%之间，无显著差异。在索引入院后，仅首次再入院就在全国产生了估计22.5亿美元的医院费用。30天再次手术率在婴儿中为34.9%，儿童中为39.2%，成人中为47.4%，老年人中为32.4%。这些差异非常显著。成人和老年人的索引手术数量是婴儿和儿童的3倍多。分流置入的估计1年再次手术率为74.2%，分流修正为63.9%，但内镜下第三脑室造瘘术仅为34.5%。列出了与无再入院生存和无再次手术生存的单变量关联。
在美国，脑积水主要是一种成人疾病。在这项基于人群的研究中，手术结果明显比研究中心报告的结果更差。脑脊液分流手术后的高再次手术率导致了这种差异。
