TY - JOUR
T1 - Laparoscopic-Assisted Versus Mini-Open Laparotomy for Ventriculoperitoneal Shunt Placement in the Medicare Population
AU - Khalid, Syed I.
AU - Nunna, Ravi S.
AU - Maasarani, Samantha
AU - Shanker, Rachyl M.
AU - Behbahani, Mandana
AU - Edmondson, Corbin P.
AU - Mehta, Ankit I.
AU - Gupta, Samir K.
AU - Chan, Edie Y.
AU - Torquati, Alfonso
AU - Byrne, Richard W.
AU - Adogwa, Owoicho
N1 - Publisher Copyright:
© 2021 Congress of Neurological Surgeons 2021.
PY - 2021/4/1
Y1 - 2021/4/1
N2 - BACKGROUND: Placement of the distal shunt catheter into the peritoneum during ventriculoperitoneal shunt (VPS) surgery can be done with either laparoscopic assistance or laparotomy. OBJECTIVE: To compare outcomes in laparoscopic-assisted vs laparotomy for placement of VPS in the Medicare population. METHODS: Patients undergoing VPS placement, between 2004 and 2014, were identified by International Classification of Disease, Ninth Revision and Current Procedural Terminology codes in the Medicare database. Demographic data including age, sex, comorbidities, and indications were collected. Six- A nd twelve-month complication rates were analyzed. RESULTS: A total of 1966 (3.2%) patients underwent laparoscopic-assisted VPS and 60 030 (96.8%) patients underwent nonlaparoscopic-assisted VPS placement. Compared with traditional open VPS placement, the laparoscopic approach was associated with decreased odds of distal revision at 6- A nd 12-mo postoperatively (6 mo: Odds ratio [OR] = 0.41, 95% confidence interval [CI]: 0.21-0.74; 12 mo: OR = 0.60, 95% CI: 0.39-0.94). At 6- A nd 12-mo postoperatively, multivariable regression analysis demonstrated increased odds of distal revision in patients with a body mass index (BMI) > 30 Kg/M2, history of open abdominal surgery, and history of laparoscopic abdominal surgery. Additionally, history of prior abdominal surgery and BMI > 30 Kg/M2 were significantly associated with increase odds of shunt infection at 6 and 12-mo, respectively. CONCLUSION: In the largest retrospective analysis to date, patients with a history of abdominal surgery and obesity were found to be at increased risk of infection and distal revision after VPS placement. However, the laparoscopic approach for abdominal placement of the distal catheter was associated with reduced rates of distal revision in this population, suggesting an avenue for reducing complications in well-selected patients.
AB - BACKGROUND: Placement of the distal shunt catheter into the peritoneum during ventriculoperitoneal shunt (VPS) surgery can be done with either laparoscopic assistance or laparotomy. OBJECTIVE: To compare outcomes in laparoscopic-assisted vs laparotomy for placement of VPS in the Medicare population. METHODS: Patients undergoing VPS placement, between 2004 and 2014, were identified by International Classification of Disease, Ninth Revision and Current Procedural Terminology codes in the Medicare database. Demographic data including age, sex, comorbidities, and indications were collected. Six- A nd twelve-month complication rates were analyzed. RESULTS: A total of 1966 (3.2%) patients underwent laparoscopic-assisted VPS and 60 030 (96.8%) patients underwent nonlaparoscopic-assisted VPS placement. Compared with traditional open VPS placement, the laparoscopic approach was associated with decreased odds of distal revision at 6- A nd 12-mo postoperatively (6 mo: Odds ratio [OR] = 0.41, 95% confidence interval [CI]: 0.21-0.74; 12 mo: OR = 0.60, 95% CI: 0.39-0.94). At 6- A nd 12-mo postoperatively, multivariable regression analysis demonstrated increased odds of distal revision in patients with a body mass index (BMI) > 30 Kg/M2, history of open abdominal surgery, and history of laparoscopic abdominal surgery. Additionally, history of prior abdominal surgery and BMI > 30 Kg/M2 were significantly associated with increase odds of shunt infection at 6 and 12-mo, respectively. CONCLUSION: In the largest retrospective analysis to date, patients with a history of abdominal surgery and obesity were found to be at increased risk of infection and distal revision after VPS placement. However, the laparoscopic approach for abdominal placement of the distal catheter was associated with reduced rates of distal revision in this population, suggesting an avenue for reducing complications in well-selected patients.
KW - Cerebrospinal fluids
KW - Hydrocephalus
KW - Hydrocephalus, Normal pressure
KW - Laparoscopic assisted surgery
KW - Medicare
KW - Minilaparotomy
KW - Ventriculoperitoneal shunt
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U2 - 10.1093/neuros/nyaa541
DO - 10.1093/neuros/nyaa541
M3 - Article
C2 - 33475722
AN - SCOPUS:85102964880
SN - 0148-396X
VL - 88
SP - 812
EP - 818
JO - Neurosurgery
JF - Neurosurgery
IS - 4
ER -