Comparison of Quality Metrics for Pediatric Shunt Surgery and Proposal of the Negative Shunt Revision Rate.

OBJECTIVE: Shunt surgery is common in pediatric neurosurgery and is associated with relevant complication rates. We aimed to compare previously published metrics in a single data set and propose the Negative Shunt Revision Rate (NSRR), defined as proportion of shunt explorations revealing a properly working system, as a new quality metric.

METHODS: Retrospective analysis of our shunt surgery activity in 2015 was performed. Demographic, clinical, and radiologic variables were extracted from electronic medical notes. Surgical Activity Rate, Revision Quotient, 30-day shunt malfunction rate, 90-day global shunt revision rate, Preventable Shunt Revision Rate, and novel NSRR were calculated.

RESULTS: Of 60 shunt operations analyzed, 18 (39%) were new shunt insertions, and 42 (70%) were revisions. Median age was 18 months (range, 0.03-204 months), and main etiologies were posthemorrhagic (n = 16; 41%), congenital (n = 11; 28%), and tumor-associated (n = 8; 21%) hydrocephalus. Within 90 days after index surgery, 13 shunt failures occurred, predominantly owing to proximal failure (n = 6; 46%). Surgical Activity Rate was 0.127, Revision Quotient was 2.333, 30-day shunt malfunction rate was 0.166, 90-day global shunt revision rate was 21.7%, and Preventable Shunt Revision Rate was 38.5%. NSRR was 7.1%.

CONCLUSIONS: Our results correlate with published values and offer measurement of quality that can be compared across studies and considered patient-oriented, easily measurable, and potentially modifiable. We propose NSRR as a new quality metric, covering an aspect of shunt surgery that was not addressed previously.