Prevalence, causes, and early outcomes of shunt revisions at a tertiary hospital in Northern Tanzania: a cross-sectional study

Abstract

Background: The mainstay treatment for patients with hydrocephalus is surgical, with ventriculoperitoneal shunt (VPS) placement being a routine practice in hospitals with limited resources and workforce. Nonetheless, avoidable complications following VPS placements are still evident, compounding significant patient morbidity and mortality. We review an analysis of the causes and outcomes of the shunt revisions. Methods: A cross-sectional study was carried out at a tertiary hospital between March 2020 and March 2023. It included 263 patients who underwent initial VPS surgeries. Postoperatively, the patients had routine follow-up care for 3 months, at which time their characteristics in relation to shunt complications were evaluated. SPSS, version 26, was utilized to analyze the data that had been gathered. Results: VPS revisions were performed on 90 of 263 patients, a prevalence of 34.2%. Of the revisions, the majority (92.2%) were pediatric patients. Females made up 52.2% of the patients. The most common reason for revisions was shunt infection (50%), followed by malposition (27.8%), blockage (15.6%), and shunt dislocation (6.7%). Surgical site infection increased the likelihood of shunt revision by 29.8%. Shunt revision was 31% more likely in operations lasting longer than 45 min. Intraoperative involvement of a junior surgical trainee raised the possibility of revision by 25%, and a revised VPS system is 13.2 times more likely to fail, integrating into longer hospital stays. Conclusion: The emphasis on lengthy surgeries and a surgeon’s skill as risk factors for revisions demonstrates a need for change in surgical practice to enhance surgical outcomes. Given the high likelihood of re-revisions after VPS revisions, it is suggested that the surgical practice of the index operation be enhanced to reduce complications. These findings serve as an initial guide for developing interventional techniques to enhance good surgical outcomes.