J Neurosurg Pediatr. 2021 Jan 29;27(4):400-405. doi: 10.3171/2020.8.PEDS20477. Print 2021 Apr 1.
CSF shunts are the most common procedures performed in the pediatric neurosurgical population. Despite attempts in multiple studies, a superior shunt valve has never been shown. Because of this, the authors aim was to examine the impact of shunt valve standardization at their institution to determine if there is a difference in surgical cost, operative time, or short-term postoperative shunt failure.
A retrospective analysis at the authors' institution was performed for all new CSF diversion shunts, as well as shunt revisions requiring a new valve, or a new valve and at least a new proximal or distal catheter over a 1-year period (January 1, 2016, to December 31, 2016). After a period of transition, neurosurgeons were encouraged to use only one type of fixed-differential-pressure valve and one type of programmable valve when performing shunt surgeries. These patients who underwent "standardized" shunt surgery over a 1-year period (January 1, 2018, to December 31, 2018) were then compared to patients in the prestandardization epoch. All patients were followed for a 12-month period after surgery. Demographic information, surgical cost, operative time, and postoperative shunt failure data were collected in all patients in the study.
The authors analyzed 87 shunt surgeries in patients prior to standardization and 94 shunt surgeries in patients after standardization. The rate of violation of the standardized shunt valve policy after implementation was 5.3% (5 of 94 procedures). When comparing the prestandardization group to those who received the standardized valve, operative costs were less ($1821.04 vs $1333.75, p = 0.0034). There was no difference in operative times between groups (78 minutes vs 81 minutes, p = 0.5501). There was no difference in total number of shunt failures between the two groups at 12 months after surgery (p = 0.0859). The rate of postoperative infection was consistent with the literature at 8%.
In accordance with quality improvement principles, the reduction of unexplained clinical variance invariably leads to a decrease in cost and, more importantly, increased value. In this study, the implementation of a standardized shunt valve decreased operative cost. There were no differences in postoperative shunt failures at 12 months after surgery and no differences in length of surgery. Standardizing shunt valves in the treatment of pediatric hydrocephalus seems to be cost-effective and safe.
脑积水分流术是小儿神经外科最常见的手术。尽管在多项研究中进行了尝试，但从未证明过一种更优的分流阀。因此，作者的目的是检查机构内分流阀标准化的影响，以确定手术成本、手术时间或短期术后分流失败是否存在差异。
对作者所在机构的所有新的脑脊髓液（CSF）分流术以及需要更换新的分流阀或至少新的近端或远端导管的分流术修订进行回顾性分析，时间为一年（2016 年 1 月 1 日至 2016 年 12 月 31 日）。在过渡阶段之后，神经外科医生在进行分流手术时被鼓励仅使用一种固定压差阀和一种可编程阀。在一年（2018 年 1 月 1 日至 2018 年 12 月 31 日）期间接受“标准化”分流手术的这些患者与标准化前时期的患者进行了比较。所有患者在手术后均随访 12 个月。在所有研究患者中收集了人口统计学信息、手术成本、手术时间和术后分流失败数据。
作者分析了标准化前的 87 例分流术患者和标准化后的 94 例分流术患者。实施后违反标准化分流阀政策的发生率为 5.3%（5/94 例手术）。将标准化前组与接受标准化阀的组进行比较，手术费用较低（1821.04 美元比 1333.75 美元，p = 0.0034）。两组手术时间无差异（78 分钟比 81 分钟，p = 0.5501）。术后 12 个月两组的总分流失败数无差异（p = 0.0859）。术后感染率与文献一致，为 8%。
根据质量改进原则，减少无法解释的临床差异必然会降低成本，更重要的是会提高价值。在这项研究中，实施标准化分流阀降低了手术成本。术后 12 个月的分流失败率无差异，手术时间也无差异。在小儿脑积水的治疗中标准化分流阀似乎是具有成本效益和安全的。
