Postoperative cerebrospinal fluid wound leakage as a predictor of shunt infection: a prospective analysis of 205 cases. Clinical article

Abstract

Object: The purpose of this study was to audit some of the risk factors for CSF shunt infections within the authors' practice and analyze the statistical significance of these factors.

Methods: The authors used their own contemporaneously collected shunt database in this study. All shunt procedures performed over a 2-year period between March 2000 and February 2002 at Great Ormond Street Hospital, London, were analyzed. For the purposes of this study, positive CSF cultures were a prerequisite for a data set to qualify as a shunt infection. The authors studied the effects of patient age, the etiology of hydrocephalus, whether the surgery was primary shunt placement versus a revision, the surgeon's level of experience, whether the surgery was performed on an elective or emergency basis, and the presence or absence of a perioperative CSF leak. Statistical analyses were performed.

Results: Two hundred and five patients with a mean (+/- SD) age at surgery of 27.9 +/- 43.0 months were included in this study. Shunt infections developed in 17 patients (8.3%) at a median of 42 days postoperatively (range 14-224 days). The presence of a perioperative CSF leak was the only variable that showed a statistically significant association with the occurrence of a shunt infection, with an infection rate of 57.1% compared to 4.7% in cases with no leak (OR 27.0 [95% CI 7.7-94.3]). The cause of hydrocephalus, elective versus emergency surgery, level of surgeon experience, a primary versus a revision procedure, and patient age did not have a bearing on the infection risk.

Conclusions: The presence of a perioperative CSF leak puts pediatric patients at a very high risk of shunt infection. Aside from prevention, the optimal management of such CSF leaks require further investigation.