Academic Journal
Predictors and causes of 30-day failure after shunt placement in pediatric hydrocephalus: a systematic review and meta-analysis.
| Τίτλος: | Predictors and causes of 30-day failure after shunt placement in pediatric hydrocephalus: a systematic review and meta-analysis. |
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| Συγγραφείς: | Di Cosmo L; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy. leonardo.dicosmo@st.hunimed.eu., Imbrogno CP; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy., El Choueiri J; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy., Nantes A; Department of Medicine, State University of Pará, Belém, Brazil., Sahgal JV; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy., Totis F; Departments of Neurological and Orthopaedic Surgery, Duke Medical Center, Duke University School of Medicine, Durham, NC, USA., Zaed I; Department of Neurosurgery, Neurocenter of South Switzerland, EOC, Lugano, Switzerland.; Department of NESMOS, Sapienza University, Rome, Italy., Jeelani NUO; Department of Pediatric Neurosurgery, Great Ormond Street Hospital, London, UK. |
| Πηγή: | Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery [Childs Nerv Syst] 2026 Oct 03; Vol. 42 (1). Date of Electronic Publication: 2026 Oct 03. |
| Τύπος έκδοσης: | Journal Article; Systematic Review; Meta-Analysis; Review |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Springer International Country of Publication: Germany NLM ID: 8503227 Publication Model: Electronic Cited Medium: Internet ISSN: 1433-0350 (Electronic) Linking ISSN: 02567040 NLM ISO Abbreviation: Childs Nerv Syst Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Berlin : Springer International, c1985- |
| Ιατρικοί όροι (MeSH): | Hydrocephalus*/surgery , Ventriculoperitoneal Shunt*/adverse effects , Ventriculoperitoneal Shunt*/trends , Postoperative Complications*/etiology , Postoperative Complications*/epidemiology , Equipment Failure*, Humans ; Child ; Risk Factors ; Treatment Failure |
| Περίληψη: | Background: Ventriculoperitoneal (VP) shunting is the most common long-term treatment for pediatric hydrocephalus; however, early shunt failure remains a significant cause of morbidity and economic burden. Although individual studies have investigated risk factors for early failure, findings are fragmented and inconsistent. This meta-analysis evaluates the prevalence, predictors, and causes of 30-day VP shunt failure in pediatric patients. Methods: Following PRISMA guidelines, databases were searched through November 2025 for studies reporting 30-day VP shunt failure in pediatric cohorts. Randomized controlled trials, prospective, and retrospective studies were included. Random-effects models were used, with risk ratios (RR) calculated for dichotomous outcomes and pooled prevalence estimated using generalized linear mixed models. Results: Our analysis included 11,596 pediatric patients, with one randomized trial and 8 observational studies. The pooled prevalence of 30-day shunt failure was 13.8% (95% CI 11.2-16.8), with significantly lower rates following primary compared with secondary shunt insertion (12.6% vs 18.0%). A separate comparative analysis confirmed this reduced risk of early failure after primary insertion (RR 0.58, 95% CI 0.49-0.69; p < 0.001). When pooled female sex was associated with decreased risk of early failure, while no hydrocephalus etiology demonstrated a significant effect. Poor ventricular catheter placement was the only modifiable predictor associated with increased risk of early failure from the pooled analyses (RR 1.64, 95% CI 1.08-2.50; p = 0.02); however, this association was based on only two studies and lost significance in leave-one-out analyses. Cause-specific failure mechanisms were poorly reported across studies. Among studies reporting these outcomes, proximal catheter obstruction and malposition were the most frequently reported mechanisms of early shunt failure, followed by shunt infection. Several additional predictors were significant in individual studies and were qualitatively reported, but could not be pooled due to heterogeneous reporting. Conclusion: VP shunt failure affects approximately one in eight pediatric patients in the first 30 days following placement, and occurs significantly more frequently following secondary shunt insertion. Among the pooled predictors, ventricular catheter placement quality represents the most significant modifiable factor associated with early shunt survival, although this finding was based on limited data. Several predictors showed estimates suggestive of increased risk; however, prospective studies with standardized reporting are necessary to define the size of these associations. Systematic Review Registration: PROSPERO CRD420261305777. (© 2026. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.) |
| Competing Interests: | Declarations. Ethics approval and consent to participate: Not applicable. Conflict of interest: The authors declare no competing interests. |
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| Contributed Indexing: | Keywords: Early shunt revision; Pediatric hydrocephalus; Risk factors; Shunt failure; Ventriculoperitoneal shunt |
| Entry Date(s): | Date Created: 20261003 Date Completed: 20261003 Latest Revision: 20261008 |
| Update Code: | 20261008 |
| DOI: | 10.1007/s00381-026-07487-3 |
| PMID: | 42829386 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1433-0350 |
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| DOI: | 10.1007/s00381-026-07487-3 |