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Implementation of an adapted perioperative ventriculoperitoneal shunting protocol in a tertiary center located in a low-to-middle-income country

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Abstract

Objective

Preventative protocols have efficaciously reduced shunt infection in developed countries. However, the generalizability of these protocols in low-to-middle-income countries (LMICs) remains unclear. Previously, shunt insertion in the authors’ center was routinely performed under institutional preventative precautions, which was updated via merging with the Hydrocephalus Clinical Research Network (HCRN) protocol. This study aimed to investigate the ventriculoperitoneal shunt (VPS) infection rates in pediatric patients following the implementation of the adapted protocol.

Methods

The adapted protocol was implemented in all first-time VPS implantations between 2011 and 2021. The primary outcome was a 6-month shunt infection. The Pearson chi-square test was used for categorical variables and the Mann-Whitney U-test for numeric variables to evaluate the correlation with shunt infection.

Results

A total of 352 first-time VPS procedures were performed adhering to the adapted protocol. The median age was 5 months, and 189 (53.7%) were male. Overall, 37 patients (10.5%) experienced shunt infection, with 30 (8.5%) occurring within the first 6 months, which was lower than 13.3% infection rate of the previous series of the same center. The infection rate was slightly higher than the 5.7% and 6.0% rates reported by HCRN studies. Patients with shunt infection were significantly younger (7.5 versus 17.5 months, P < 0.001).

Conclusions

This study validates the efficacy of an adapted perioperative protocol in mitigating shunt infection in a high-volume center in a LMIC. Adhering to a step-by-step protocol, modified to suit the healthcare resources and financial constraints of LMICs, could maintain low shunt infection rates that are roughly comparable to those of centers in high-income countries.

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Queries about the data should be directed to the corresponding author.

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Authors and Affiliations

  1. Department of Pediatric Neurosurgery, Children’s Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Ataollah Shahbandi, Pedram Jahangiri, Keyvan Tayebi Meybodi, Farideh Nejat & Zohreh Habibi

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Contributions

A. Sh., acquisition of data, analysis and interpretation of data, drafting the manuscript; P. J., revising the manuscript; K.T. M., conception and design of the work, revising the manuscript; F. N., checking all aspects of the work in ensuring the accuracy or integrity of any part of the work; Z. H., conception and design of the work, checking all aspects of the work in ensuring the accuracy or integrity of any part of the work, final approval of the version to be published. All authors reviewed the manuscript.

Corresponding author

Correspondence to Zohreh Habibi.

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Ethics approval

Institutional ethical approval code: IR.TUMS.CHMC.REC.1400.183. The study adhered to the tenets of the Declaration of Helsinki.

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Informed consent to use clinical data for research purposes had been taken from parents at admission time.

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Consent for publication was taken from parents, conditioning that the patients’ identity is not recognizable.

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The authors have no conflict of interest/competing interest.

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Shahbandi, A., Jahangiri, P., Meybodi, K.T. et al. Implementation of an adapted perioperative ventriculoperitoneal shunting protocol in a tertiary center located in a low-to-middle-income country. Childs Nerv Syst (2024). https://doi.org/10.1007/s00381-024-06374-z

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