1Division of Neurosurgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
2Department of Neurosurgery, University of Utah, Salt Lake City, Utah.
J Neurosurg Pediatr. 2020 Dec 18;27(3):269-276. doi: 10.3171/2020.7.PEDS20142. Print 2021 Mar 1.
Analysis of temporal trends in patient populations and procedure types may provide important information regarding the evolution of hydrocephalus treatment. The purpose of this study was to use the Hydrocephalus Clinical Research Network's Core Data Project to identify meaningful trends in patient characteristics and the surgical management of pediatric hydrocephalus over a 9-year period.
The Core Data Project prospectively collected patient and procedural data on the study cohort from 9 centers between 2008 and 2016. Logistic and Poisson regression were used to test for significant temporal trends in patient characteristics and new and revision hydrocephalus procedures.
The authors analyzed 10,149 procedures in 5541 patients. New procedures for hydrocephalus (shunt or endoscopic third ventriculostomy [ETV]) decreased by 1.5%/year (95% CI -3.1%, +0.1%). During the study period, new shunt insertions decreased by 6.5%/year (95% CI -8.3%, -4.6%), whereas new ETV procedures increased by 12.5%/year (95% CI 9.3%, 15.7%). Revision procedures for hydrocephalus (shunt or ETV) decreased by 4.2%/year (95% CI -5.2%, -3.1%), driven largely by a decrease of 5.7%/year in shunt revisions (95% CI -6.8%, -4.6%). Concomitant with the observed increase in new ETV procedures was an increase in ETV revisions (13.4%/year, 95% CI 9.6%, 17.2%). Because revisions decreased at a faster rate than new procedures, the Revision Quotient (ratio of revisions to new procedures) for the Network decreased significantly over the study period (p = 0.0363). No temporal change was observed in the age or etiology characteristics of the cohort, although the proportion of patients with one or more complex chronic conditions significantly increased over time (p = 0.0007).
Over a relatively short period, important changes in hydrocephalus care have been observed. A significant temporal decrease in revision procedures amid the backdrop of a more modest change in new procedures appears to be the most notable finding and may be indicative of an improvement in the quality of surgical care for pediatric hydrocephalus. Further studies will be directed at elucidation of the possible drivers of the observed trends.
分析患者人群和手术类型的时间趋势，可为脑积水治疗的演变提供重要信息。本研究旨在使用脑积水临床研究网络的核心数据项目，确定 9 年来小儿脑积水患者特征和手术管理方面的有意义趋势。
该核心数据项目前瞻性地收集了 2008 年至 2016 年间 9 个中心的研究队列的患者和手术数据。采用逻辑和泊松回归检验患者特征和新的和修正的脑积水手术的显著时间趋势。
作者分析了 5541 例患者的 10149 例手术。新的脑积水手术（分流或内镜第三脑室造瘘术[ETV]）每年减少 1.5%（95%CI-3.1%，+0.1%）。在研究期间，新的分流术每年减少 6.5%（95%CI-8.3%，-4.6%），而新的 ETV 手术每年增加 12.5%（95%CI9.3%，15.7%）。脑积水的修正手术（分流或 ETV）每年减少 4.2%（95%CI-5.2%，-3.1%），主要是由于分流修正手术减少了 5.7%/年（95%CI-6.8%，-4.6%）。随着新的 ETV 手术数量的增加，ETV 修正手术的数量也随之增加（每年 13.4%，95%CI9.6%，17.2%）。由于修正手术的速度快于新手术，因此该网络的修正率（修正手术与新手术的比值）在研究期间显著下降（p=0.0363）。虽然患者中患有一种或多种复杂慢性疾病的比例随着时间的推移显著增加（p=0.0007），但队列的年龄或病因特征在观察期间没有发生变化。
在相对较短的时间内，脑积水治疗发生了重要变化。在新手术数量略有变化的情况下，修正手术数量显著减少，这似乎是最显著的发现，可能表明小儿脑积水手术护理质量有所提高。进一步的研究将致力于阐明观察到的趋势的可能驱动因素。
