1Department of Neurosurgery, St. Olavs University Hospital, Trondheim; and.
Departments of2Neuroscience and.
J Neurosurg. 2023 Feb 3;139(3):892-900. doi: 10.3171/2022.12.JNS222083. Print 2023 Sep 1.
Indications for surgical treatment of hydrocephalus (HC) can vary across centers. The authors sought to investigate the frequencies of surgically treated HC disorders and to study variations in the practice of shunt surgery in Norway, a country with universal and free healthcare.
This is a nationwide registry-based study using data from the Norwegian Patient Registry. Four neurosurgical centers serve exclusively in 4 defined geographic regions. All patients who underwent shunt surgery in Norway between January 1, 2008, and December 31, 2021, were included and regional differences and time trends were explored.
The national annual rate of shunt surgery in the study period was 6.0 per 100,000. A total of 4139 individuals (49.5% male) underwent primary shunt surgeries, and a total of 9262 operations including revision surgeries were performed. There were statistically significant regional differences between the 4 treating centers in Norway in terms of patients' age (median 61 years, range 53-65 years); mean annual rate of primary shunt surgery (5.1-7.6 per 100,000); annual rate of primary shunt surgery in patients of different age groups (0.9-1.2 in 0-17 years, 1.8-2.7 in 18-64 years, and 1.6-3.9 in ≥ 65 years); annual rate of revision surgeries (2.4-5.7 per 100,000); annual rate of primary surgery for communicating HC (0.7-2.0 per 100,000); annual rate of primary surgery for normal pressure HC (0.5-1.8 per 100,000); and annual rate of primary surgery for HC associated with cerebrovascular disease (0.5-2.0 per 100,000). There was significant variation in overall shunt surgeries during the study period (p = 0.026), and there was an overall decrease in revision surgeries over time (p < 0.001). There appears to be a homogenization of revision surgeries over time.
There are significant and large practice variations in the surgical management of HC in Norway. There are significant differences between regions, particularly in terms of rates of shunt surgery for some diagnoses (communicating HC, normal pressure HC, and HC associated with cerebrovascular disease) as well as revision rates.
脑积水（HC）的手术治疗指征在各中心可能存在差异。作者旨在研究挪威接受手术治疗的 HC 疾病的频率，并研究该国在分流手术实践中的差异，挪威实行全民免费医疗。
这是一项基于全国登记的研究，使用了挪威患者登记处的数据。四个神经外科中心专门服务于四个定义明确的地理区域。2008 年 1 月 1 日至 2021 年 12 月 31 日期间在挪威接受分流手术的所有患者均被纳入研究，并对区域差异和时间趋势进行了探讨。
研究期间，全国每年分流手术的发生率为 6.0/10 万。共有 4139 名患者（49.5%为男性）接受了初次分流手术，共进行了 9262 次包括修正手术在内的手术。在挪威的 4 个治疗中心之间，患者年龄（中位数为 61 岁，范围为 53-65 岁）、初次分流手术的年平均发生率（5.1-7.6/10 万）、不同年龄组患者初次分流手术的年发生率（0-17 岁为 0.9-1.2，18-64 岁为 1.8-2.7，≥65 岁为 1.6-3.9）、修正手术的年发生率（2.4-5.7/10 万）、交通性 HC 的初次手术率（0.7-2.0/10 万）、正常压力性 HC 的初次手术率（0.5-1.8/10 万）和与脑血管疾病相关的 HC 的初次手术率（0.5-2.0/10 万）方面存在统计学显著差异。在研究期间，整体分流手术的数量存在显著差异（p = 0.026），并且随着时间的推移，修正手术的数量总体呈下降趋势（p < 0.001）。修正手术的时间趋势似乎呈现出同质化。
在挪威，HC 的手术治疗管理存在显著且较大的实践差异。不同地区之间存在显著差异，特别是在某些诊断（交通性 HC、正常压力性 HC 和与脑血管疾病相关的 HC）的分流手术率以及修正率方面。
