韩国动脉瘤性蛛网膜下腔出血患者的分流依赖性脑积水和分流失败率。

Shunt-dependent hydrocephalus and shunt failure rate in patients with aneurysmal subarachnoid hemorrhage in Korea.

机构信息

1Department of Neurosurgery, Hanyang University Guri Hospital, Gyeonggi-do.

2Department of Neurosurgery, Uijeongbu Eulji Medical Center, Eulji University College of Medicine, Uijeongbu; and.

出版信息

J Neurosurg. 2024 May 24;141(5):1254-1261. doi: 10.3171/2024.2.JNS232933. Print 2024 Nov 1.

DOI:10.3171/2024.2.JNS232933

PMID:38788231

Abstract

OBJECTIVE

Shunt-dependent hydrocephalus is a major complication of aneurysmal subarachnoid hemorrhage (SAH). Despite this, the factors influencing shunt dependency and shunt failure remain unclear. Therefore, the aim of this study was to estimate shunt dependency and failure rates and determine the contributing factors in patients with aneurysmal SAH using the Korean National Health Insurance database over a 13-year period.

METHODS

Patients with aneurysmal SAH aged > 18 years who underwent surgical procedures were included. Using the shunt surgery prescription data, the shunt-dependent hydrocephalus rate was evaluated according to sex, age, aneurysm location, and year of admission. Among patients who underwent shunt surgery, the shunt failure rate was estimated using surgical prescription data.

RESULTS

A total of 57,030 patients with SAH who underwent aneurysm surgery were included. The overall raw rate of shunt-dependent hydrocephalus was 15.0% (8530/57,030). Age (HR 1.04, 95% CI 1.04-1.04; p < 0.001) and endovascular coiling (vs surgical clipping, HR 0.71, 95% CI 0.67-0.74; p < 0.001) were related to shunt-dependent hydrocephalus in the multivariate logistic regression analysis. Posterior circulation and anterior communicating aneurysms showed a high risk of shunt dependency. Among 8530 patients who underwent shunt surgery, the shunt failure rate was 11.3% (961/8530). Female sex (HR 1.18, 95% CI 1.01-1.39; p = 0.0324), age (HR 0.99, 95% CI 0.98-0.99; p < 0.001), early shunt placement (HR 1.25, 95% CI 1.08-1.47; p = 0.004) and lumboperitoneal shunt placement (HR 2.19, 95% CI 1.65-2.91; p < 0.001) were the risk factors for shunt failure in the multivariate logistic regression analysis.

CONCLUSIONS

The rate of shunt-dependent hydrocephalus after aneurysmal SAH was 15.0% in this study using a medical claims database in Korea. The shunt surgery rate was highest in patients in their 60s and 70s. Shunt failure occurred in 11.3% of the patients, and a lumboperitoneal shunt was most related to the need for revision surgery.

摘要

目的

分流依赖性脑积水是蛛网膜下腔出血（SAH）的主要并发症。尽管如此，影响分流依赖和分流失败的因素仍不清楚。因此，本研究旨在使用韩国国家健康保险数据库，在 13 年期间估计动脉瘤性 SAH 患者的分流依赖和失败率，并确定相关因素。

方法

纳入年龄>18 岁并接受手术治疗的动脉瘤性 SAH 患者。使用分流手术处方数据，根据性别、年龄、动脉瘤位置和入院年份评估分流依赖性脑积水的发生率。在接受分流手术的患者中，使用手术处方数据估计分流失败率。

结果

共纳入 57030 例接受动脉瘤手术的 SAH 患者。总体上，分流依赖性脑积水的原始发生率为 15.0%（8530/57030）。年龄（HR 1.04，95%CI 1.04-1.04；p<0.001）和血管内弹簧圈治疗（vs 手术夹闭，HR 0.71，95%CI 0.67-0.74；p<0.001）是多变量逻辑回归分析中与分流依赖性脑积水相关的因素。后循环和前交通动脉瘤显示出较高的分流依赖风险。在 8530 例接受分流手术的患者中，分流失败率为 11.3%（961/8530）。女性（HR 1.18，95%CI 1.01-1.39；p=0.0324）、年龄（HR 0.99，95%CI 0.98-0.99；p<0.001）、早期分流放置（HR 1.25，95%CI 1.08-1.47；p=0.004）和腰大池分流术（HR 2.19，95%CI 1.65-2.91；p<0.001）是多变量逻辑回归分析中分流失败的危险因素。