Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2025
Epidemiology of cerebrospinal fluid shunt surgery in Australia and New Zealand (2017-2024).
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Thirunavukarasu Vignaraja, Taylor Michael, Dexter Mark
Аннотация
BACKGROUND: Hydrocephalus-related procedures constitute approximately one-third of neurosurgical interventions annually, with incidence rates ranging from 30 to 300 per 100,000 population, varying by region, age and aetiology. Despite advancements in surgical techniques and shunt devices, cerebrospinal fluid (CSF) shunts exhibit high complication and failure rates, necessitating frequent revisions due to issues such as overdrainage, underdrainage, infections and mechanical failures. This study leverages data from the Australasian Shunt Registry (ASR) to define the epidemiology of shunt surgery in Australia and Aotearoa New Zealand, addressing a critical gap in regional data.
METHODS: A retrospective, multicentre, registry-based study analysed 8 years of data (January 2017-December 2024) from the ASR, established in 2016 by the Neurosurgical Society of Australasia. The study included 7238 procedures across 5220 patients from 63 sites (37 public, 26 private), encompassing primary insertions, revisions, and other shunt-related procedures. Incidence rates were calculated per 100,000 person-years using population estimates (Australia ∼ 25.8 million, New Zealand ∼ 5 million), stratified by age (infants < 1 year, children 1-<18 years, adults ≥ 18 years). Survival analysis employed Kaplan-Meier estimation and Cox regression to assess revision risks related to operator role and surgery duration, with analyses conducted using R (version 4.4.1).
RESULTS: The overall incidence of primary shunt insertions was 1.64 per 100,000 person-years, with age-specific rates of 15.8 (infants), 1.3 (children), and 1.5 (adults). Revisions accounted for 35.5 % of procedures, with one-year and 90-day revision rates at 9.3 % and 5.6 %, respectively. Common diagnoses included haemorrhage (44.6 % infants), tumours (32.4 % children), and idiopathic normal pressure hydrocephalus (26.2 % adults). Surgery durations exceeding 2 h doubled revision risk (HR 2.06, p < 0.001), potentially linked to increased infection risk.
CONCLUSIONS: This first ASR report defines the epidemiology of shunt surgery across Australia and Aotearoa New Zealand compared to UK and Norwegian benchmarks. It contributes to the knowledge base of this complex patient population, ultimately aiding clinical outcomes and economic burden reduction.
METHODS: A retrospective, multicentre, registry-based study analysed 8 years of data (January 2017-December 2024) from the ASR, established in 2016 by the Neurosurgical Society of Australasia. The study included 7238 procedures across 5220 patients from 63 sites (37 public, 26 private), encompassing primary insertions, revisions, and other shunt-related procedures. Incidence rates were calculated per 100,000 person-years using population estimates (Australia ∼ 25.8 million, New Zealand ∼ 5 million), stratified by age (infants < 1 year, children 1-<18 years, adults ≥ 18 years). Survival analysis employed Kaplan-Meier estimation and Cox regression to assess revision risks related to operator role and surgery duration, with analyses conducted using R (version 4.4.1).
RESULTS: The overall incidence of primary shunt insertions was 1.64 per 100,000 person-years, with age-specific rates of 15.8 (infants), 1.3 (children), and 1.5 (adults). Revisions accounted for 35.5 % of procedures, with one-year and 90-day revision rates at 9.3 % and 5.6 %, respectively. Common diagnoses included haemorrhage (44.6 % infants), tumours (32.4 % children), and idiopathic normal pressure hydrocephalus (26.2 % adults). Surgery durations exceeding 2 h doubled revision risk (HR 2.06, p < 0.001), potentially linked to increased infection risk.
CONCLUSIONS: This first ASR report defines the epidemiology of shunt surgery across Australia and Aotearoa New Zealand compared to UK and Norwegian benchmarks. It contributes to the knowledge base of this complex patient population, ultimately aiding clinical outcomes and economic burden reduction.