Assessing Safety and Timing of Ventriculoperitoneal Shunt and Gastrostomy Tube Placement in Newborns.

BACKGROUND

Ventriculoperitoneal Shunt placement (VPS) is a common surgical procedure for treating newborns with hydrocephalus. Due to poor feeding, these patients often require a gastrostomy tube (GT). There is controversy regarding safety and outcomes when patients require a VPS and GT.

METHODS

The Nationwide Readmission Database (NRD) was queried from 2016 to 2020 for newborns who underwent VPS placement during newborn hospitalization. Patient characteristics and outcomes were compared between those also requiring GT placement to those undergoing VPS alone. The timing of surgeries was also investigated.

RESULTS

4012 patients met inclusion criteria: 597 patients with VPS + GT placement and 3415 received only a VPS. Those undergoing VPS + GT had an increased proportion of shunt infection (3.2 % vs. 1.1 %) and mechanical complications (5.4 % vs. 0.7 %), often necessitating early removal (17 % vs. 12 %), all p < 0.05. The readmission rate was higher in those with VPS + GT, as were overall shunt complications upon readmission (11 % vs. 8 %, p = 0026). Regarding the timing of VPS and GT, those undergoing GT before VPS had higher rates of shunt and wound complications in newborn hospitalization, as well as shunt and GT complications upon readmission.

CONCLUSION

In this nationwide retrospective cohort analysis, placement of gastrostomy tubes during the same hospitalization as ventriculoperitoneal shunts increased shunt complications. In addition, the timing of shunt placement was found to be more favorable before gastrostomy placement. These findings should be considered for patients requiring both procedures.

TYPE OF STUDY: Retrospective cohort.

LEVEL OF EVIDENCE: Level III.