Affiliations: [a] Center for Surgical Outcomes Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA | [b] Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA | [c] Section of Pediatric Urology, Nationwide Children’s Hospital, Columbus, OH, USA
Correspondence:
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Corresponding author: Daryl J. McLeod, Section of Pediatric Urology and Center for Surgical Outcomes Research, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA. Tel.: +1 614 722 3544; E-mail: [email protected].
Abstract: PURPOSE: Most patients with spina bifida require ventriculoperitoneal (VP) shunt placement. Some also require bladder augmentation, which may increase the risk of VP shunt malfunction and/or failure. The aim of this study was to assess whether bladder augmentation affects the rate of VP shunt failure in this population. METHODS: Using the Pediatric Health Information System, we studied patients with spina bifida born between 1992 and 2014 who underwent VP shunt placement. Using conditional logistic regression, we compared age- and hospital-matched patients who did and did not undergo a bladder augmentation to determine their difference in rates of VP shunt failure. RESULTS: There were 4192 patients with spina bifida who underwent both surgical closure and VP shunt placement. Of these, 203 patients with bladder augmentation could be matched to 593 patients without bladder augmentation. VP shunt failure occurred within 2 years in 7.7% of patients, the majority of whom were in the group who underwent bladder augmentation (87%). After adjusting for confounders, undergoing bladder augmentation was independently associated with VP shunt failure (HR: 33.5, 95% CI: 13.15–85.44, p< 0.001). CONCLUSION: Bladder augmentation appears to be associated with VP shunt failure. Additional studies are necessary to better define this relationship and identify risk-reduction techniques.
