Prevalence and factors associated with shunt survival among hydrocephalus patients that underwent ventriculoperitoneal shunt surgery at Mulago National Referral Hospital: a retrospective cross-sectional study

Abstract

Introduction: Ventriculoperitoneal shunt (VPS) surgery is one of the mainstay treatments for hydrocephalus patients. Some patients that undergo ventriculoperitoneal shunt surgery experience eventful survival. However, limited information exists on the extent of VPS surgery among hydrocephalus patients and factors associated with shunt survival at neurosurgical unit of Mulago National Referral Hospital (MNRH). Objective: To determine the prevalence and factors associated with shunt survival among hydrocephalus patients that underwent VPS surgery at Neurosurgical Unit of MNRH. Methods: A 5-year retrospective cross-sectional study was conducted on 104 hydrocephalus patients. A review of patients’ medical charts and outpatient follow-up records along with a telephone survey were done. Pre-structured questionnaires were used to collect data. Data was exported to STATA version 17.0 for statistical analysis. Bivariate and multivariate logistic regression was used to assess for association. Results: Prevalence of VPS surgery at MNRH was 35.0%. Majority of patients were male (56.0%). Mean age of patients was 21.0 ± 21.2 years. Obstructive and communicating hydrocephalus were found in 69.0% (72) and 31.0% (32) of patients respectively. The majority of the patients had non-PIH 83.0% (86). A shunt failure rate of 34.6% was recorded in this study. Shunt infection and shunt malfunction rates were similar at 10.6% respectively. Etiology of hydrocephalus was found to be a significant factor affecting shunt survival (95% CI 0.032-0.775; p=0.023). Conclusion: VPS insertion was relatively low (35.0%) among hydrocephalus patients that presented at neurosurgical unit of MNRH. The 1-year shunt survival was 65.4%. One in three patients that had VPS surgery developed complications including shunt failure, shunt malfunction and mortality. Patients with non-PIH were less likely to experience shunt failure.