Backlund Alexandra, Kristiansson Helena, Fletcher-Sandersjöö Alexander, Arvidsson Lisa
Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
World Neurosurg. 2025 Mar;195:123737. doi: 10.1016/j.wneu.2025.123737. Epub 2025 Feb 24.
Hydrocephalus is a common neurosurgical condition treated primarily through ventriculoperitoneal (VP) shunt placement. This study aims to investigate the relationship between the timing of VP shunt surgery (on-call vs. regular hours) and shunt failure rates.
In this single-center, population-based observational cohort study, all adult patients who underwent VP shunt surgery were included. The main outcome was reoperation due to shunt failure within 12 months of the index surgery, comparing rates between procedures performed during regular hours and on-call periods. Adjustments for confounders were made using multivariable logistic regression.
Out of 810 cases included, 25% underwent surgery during on-call hours. Shunt failure occurred in 10% of cases, most often due to infection. Patients operated on during on-call hours had a significantly higher rate of shunt failure compared to those operated on during regular hours (17% vs. 7.9%, P < 0.001). However, after adjusting for confounders in a multivariable logistic regression, this relationship was no longer statistically significant (OR: 1.60, P = 0.073).
The rate of shunt failure was significantly greater in surgeries conducted during on-call hours as opposed to regular hours, but this was not statistically significant after adjusting for confounders. Therefore, the timing of VP shunt surgery may not be an independent risk factor for shunt failure. High-risk scenarios still deserve added caution, and further research is needed to identify factors influencing shunt outcomes and develop strategies to minimize failure rates.
脑积水是一种常见的神经外科疾病，主要通过脑室腹腔（VP）分流术进行治疗。本研究旨在探讨VP分流手术时机（随叫随到时间与正常工作时间）与分流失败率之间的关系。
在这项基于人群的单中心观察性队列研究中，纳入了所有接受VP分流手术的成年患者。主要结局是在初次手术12个月内由于分流失败而进行再次手术，比较正常工作时间和随叫随到时间进行的手术之间的失败率。使用多变量逻辑回归对混杂因素进行调整。
在纳入的810例病例中，25%在随叫随到时间进行手术。10%的病例发生分流失败，最常见的原因是感染。与在正常工作时间进行手术的患者相比，在随叫随到时间进行手术的患者分流失败率显著更高（17%对7.9%，P<0.001）。然而，在多变量逻辑回归中对混杂因素进行调整后，这种关系不再具有统计学意义（比值比：1.60，P=0.073）。
与正常工作时间相比，在随叫随到时间进行的手术中分流失败率显著更高，但在对混杂因素进行调整后，这一差异无统计学意义。因此，VP分流手术的时机可能不是分流失败的独立危险因素。高风险情况仍值得格外谨慎，需要进一步研究以确定影响分流结果的因素，并制定将失败率降至最低的策略。
