Hallan David R, Rizk Elias
Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA.
Cureus. 2022 Apr 3;14(4):e23776. doi: 10.7759/cureus.23776. eCollection 2022 Apr.
Background Debate exists about the safety of ventriculoperitoneal shunt placement in the presence of a gastrostomy tube and the timing of these procedures from each other. Using a large database, we sought to determine the rates of shunt infection and revision in patients who had both devices placed, based on the timing between procedures. Methods We performed a retrospective database analysis using a multi-institutional database (TriNetX), looking at all patients diagnosed with gastrostomy tube with subsequent ventriculoperitoneal shunt placement and vice-versa. We also evaluated patients who had gastrostomy tubes and shunts placed at the same time. We categorized cohorts into patients with device placement after 1-10 days, 11-30 days, and after one month of the other. Our primary endpoints were shunt infection and shunt revision. Results Patients who had same-day gastrostomy tube and shunt placement had a shunt infection rate of 10.06% within five years, and 14.53% had a shunt revision. With prior shunting and subsequent gastrostomy tube placement within 1-10 days, 12.18% had shunt infections, and 17.88% had shunt revisions; for those who had subsequent gastrostomy tube placement within 11-30 days, shunt infections were seen in 10.57%, and shunt revisions in 19.41%; gastrostomy tube placement after one month or longer of shunt placement resulted in 15.39% of patients having shunt infections and 17.73% with shunt revision. Prior gastrostomy tube patients with subsequent shunt placement, within 1-10 days had shunt infection rates of 8.27% and revision rates of 14.39%; for shunt placement within 11-30 days, shunt infections were seen in 10.82%, and shunt revisions were done in 14.33% of patients; for shunt placement after one month or longer, shunt infection rate was 11.68%, and revision rate was 16.80%. Conclusions Our results demonstrate no significant difference in shunt infection rates and shunt revision rates between same-day gastrostomy tube and shunt placement versus placement within 1-10 days, 11-30 days, or any time after one month from one another.
背景 对于在存在胃造瘘管的情况下进行脑室腹腔分流术的安全性以及这两种手术相互之间的时机选择存在争议。我们利用一个大型数据库，试图根据手术间隔时间来确定同时植入这两种装置的患者的分流感染率和翻修率。方法 我们使用一个多机构数据库（TriNetX）进行回顾性数据库分析，观察所有诊断为胃造瘘管并随后进行脑室腹腔分流术的患者，反之亦然。我们还评估了同时植入胃造瘘管和分流器的患者。我们将队列分为在另一个装置植入后1 - 10天、11 - 30天以及一个月后植入装置的患者。我们的主要终点是分流感染和分流翻修。结果 同日植入胃造瘘管和分流器的患者在五年内的分流感染率为10.06%，14.53%的患者进行了分流翻修。在先前进行分流术且随后在1 - 10天内植入胃造瘘管的患者中，12.18%发生了分流感染，17.88%进行了分流翻修；对于那些在11 - 30天内随后植入胃造瘘管的患者，分流感染率为10.57%，分流翻修率为19.41%；在分流术植入一个月或更长时间后植入胃造瘘管导致15.39%的患者发生分流感染，17.73%的患者进行了分流翻修。先前有胃造瘘管的患者随后在1 - 10天内进行分流术，分流感染率为8.27%，翻修率为14.39%；在11 - 30天内进行分流术，10.82%的患者发生分流感染，14.33%的患者进行了分流翻修；在一个月或更长时间后进行分流术，分流感染率为11.68%，翻修率为16.80%。结论 我们的结果表明，同日植入胃造瘘管和分流器与在1 - 10天、11 - 30天或彼此一个月后的任何时间植入相比，分流感染率和分流翻修率没有显著差异。
