Abstract
Purpose: Shunt insertion is the treatment of choice in many hydrocephalus cases. However, one of its common complications that increases its mortality and morbidity rate is infection, as our center yielded 32% infection rate post-shunting. Thus, this paper aims to develop new shunt protocol to reduce the infection rate post-shunting.
Methods: A prospective cohort study was conducted from 2017 to 2022 in a single institution in Saudi Arabia. Data from ninety-two hydrocephalus patients who required shunt insertion was collected and followed up for 6 months.
Result: Ninety-two procedures for a total number of sixty-five cases were analyzed. The age average was 141.4 months (SD=232.9), and 73.9% of the procedures were done on males. The average compliance to the new protocol was 90.9%. Culture results were missed in 8 cases, and positive in 4.8% only (4 cases) giving a ratio of 1 per 23 cases. All infected patients were males, 75% were aging less than a month when operated. Twenty-eight elements of the new protocol were analyzed by Fisher’s Exact Test. Multilayered wound closure with antibiotic was significantly associated with less infection rate (LR=7.5, Fisher’s Exact Test p-value=.024). Other elements were statistically insignificant.
Conclusion: Development and following new shunt protocols could reduce infection rate especially in areas where they have high post-shunting infection rate. Although, one element was statistically significant, other components were clinically or “financially” significant, particularly those which are technical, and must be considered.