460 - Complications and Outcomes of Infants with Posthemorrhagic Hydrocephalus: Analysis from the National Surgical Quality Improvement Program (NSQIP)

Poster Number: 460
Publication Number: 460.342

Erwin T. Cabacungan, Medical College of Wisconsin, Wauwatosa, Wisconsin/53202, WI, United States; Samuel J. Adams, Medical College of Wisconsin, Milwaukee, WI, United States; Katherine A. Carlton, Medical College of Wisconsin, Mequon, WI, United States; Andrew B. Foy, Medical College of Wisconsin, Milwaukee, WI, United States; Susan Cohen, Medical College of Wisconsin, Milwaukee, WI, United States

Background: Post-hemorrhagic hydrocephalus (PHH) remains a significant problem affecting premature infants. Incidence of PHH continues to rise, yet lack of strong evidence has led to variations in neurosurgical interventions. There is a move towards standardization for care but understanding complications and outcomes with current practice is needed. Collaborative quality improvement databases provide risk-adjusted data to address this problem.

Objective: To identify complications and outcomes of infants with PHH receiving their first cerebrospinal fluid (CSF) shunt procedure.

Design/Methods: We conducted a retrospective cohort study of premature infants with PHH who underwent CSF shunt procedure using the 2016 -2019 NSQIP pediatric CSF procedure-targeted data set. Predictor variable was type of primary neurological intervention: no prior temporizing procedures (NTP) vs. prior temporizing procedures (TP). Patient characteristics, risk factors before surgery, and short-term complications and outcomes were collected. Statistical analysis included Chi-square, Poisson or logistic multivariable regression, and analysis was adjusted for covariables.

Results: Majority of infants had TP (516/889, 58%), with ventricular reservoir being the most common procedure performed (284/516, 55%). Compared to NTP infants, total length of hospital stay was longer for infants with TP even after adjustments (aIRR=1.56 (1.49-1.63), p< 0.001, Figure 1). Nearly 60% (521/889) of the entire cohort were diagnosed with bronchopulmonary dysplasia (BPD). Infants with TP were younger gestational age, lower birth weight, were already diagnosed with BPD, required nutritional support at time of surgery, and had shunt surgery later (Table 1). Infants with TP were more likely to be discharged with oxygen, but no difference was seen in need for shunt revision. Infants with TP required less nutritional support at discharge (Table 2, aOR 0.42 (0.19-0.89), β= -0.108, p=0.025). Regression model analysis revealed steroid use within 30 days before shunt surgery was positively associated with death (β=0.215, p< 0.001) and need for shunt revision (β=0.135, p=0.009).Conclusion(s): TP has emerged to be a common primary procedure for infants with PHH, and infants with TP had more feeding issues before shunt surgery but appeared to be protected from feeding problems at discharge. BPD is a common comorbidity with PHH, and postnatal steroid use was associated with increased need for shunt revision and death. Medical management can be guided by collaborative risk-adjusted database results to reduce complications and improve outcomes.
Figure 1. Box plots of the total hospital length of stay (days), NTP vs. TP.†There is a higher median total length of stay for Prior Temporizing Procedures (TP), median (25th-75th%ile) = 39 days (2 -80) vs. No Prior Temporizing Procedures (NTP), median (25th – 75th%ile) = 7 days (2 -36).† This significance remains after adjustment with covariates patient characteristics and risk factors (TP - aIRR (95th CI) = 1.56 (1.49 -1.63), with NTP as reference .† †
Table 1. Patient characteristics, risk factors, and short-term outcomes and complications for PHH infants, NTP vs. TP.Infants with prior temporizing procedures (TP) were of younger gestational age, lower birth weight, higher number diagnosed with bronchopulmonary dysplasia, required more nutritional support at the time of surgery, had shunt surgery later, and higher number with oxygen at discharge, compared to those infants with no prior temporizing procedures (NTP).