Ventriculoperitoneal Shunt and Gastrostomy Tube Placement and Timing: A Database Analysis

Patients with neurologic damage requiring a ventriculoperitoneal shunt (VPS) typically additionally require gastrostomy tube (G-tube) placement for dietary assist. Likewise, sufferers with neurologic damage requiring a G-tube for dietary assist might also have hydrocephalus requiring a VPS [1]. However, there’s debate concerning the security of ventriculoperitoneal shunt placement within the presence of a gastrostomy tube, and vice-versa, and the timing of such procedures from one another. The discourse stands on the chance of shunt malfunction and shunt an infection with bacterial pathogens associated to a G-tube [1-6]. Therefore, we sought to find out the shunt an infection charges and shunt revision in sufferers who had each gadgets positioned, primarily based on the timing between procedures, utilizing a big database. 

This was a retrospective comparative case-control examine. We used a de-identified database community (TriNetX) to retrospectively question through ICD-10 and present procedural terminology codes to guage all sufferers with a previous G-tube placement with subsequent VPS placement, in addition to sufferers with a previous VPS with subsequent G-tube placement. We additionally evaluated sufferers who had G-tubes and VPS positioned on the identical time. We categorized placement into cohorts for these sufferers who had system placement after 1-10 days, 11-30 days, and after one month of the opposite. Data had been obtained from 62 well being care organizations (HCOs) spanning 11 international locations. The database consists of variables on demographics, diagnoses, drugs, laboratory values, genomics, and procedures. The id of the HCOs and sufferers shouldn’t be disclosed to adjust to moral tips relating to knowledge re-identification. Because of the database’s federated nature, an IRB waiver has been granted. Our use of this database and its validity has been disclosed by earlier literature, and actual particulars of the community have been beforehand described [7-10].

The medical info included age on the preliminary process (index) date, in addition to intercourse, race, and comorbidities of hypertension, acute kidney damage, diabetes, ischemic coronary heart illness, coronary heart failure, atrial fibrillation, issues of lipoprotein metabolism issues, and different dyslipidemias, weight problems, historical past of nicotine dependence, power respiratory illness, cirrhosis, alcohol abuse or dependence, and peripheral vascular illness, recorded as much as the date of the index date. Our major outcomes of curiosity had been shunt an infection and shunt revision charges. These outcomes had been obtained over 5 years. Chi-square evaluation was carried out on categorical variables. Comparisons had been made between same-day G-tube and shunt versus every cohort. 

We recognized 4,269 sufferers with a VPS and G-tube. In addition, 179 (4.19%) sufferers had a VPS and G-tube positioned the identical day, 509 (11.92%) sufferers with a previous VPS and G-tube placement inside 1-10 days, 814 (19.07%) inside 11-30 days, and 897 (21.01%) with placement after one month. Thus, there have been 278 (6.51%) sufferers with prior G-tube and placement of a VPS inside 1-10 days, 342 (8.01%) inside 11-30 days, and 1,250 (29.28%) with placement after one month. Baseline demographics and traits may be seen in Table 1.

Patients who had same-day G-tube and VPS placement had a VPS an infection fee of 10.06% inside 5-years, and 14.53% had a VPS revision. In the prior VPS group with subsequent G-tube placement inside 1-10 days, 12.18% had VPS infections (p=0.45), and 17.88% had VPS revisions (p=0.30); for individuals who had subsequent G-tube placement inside 11-30 days, VPS infections had been seen in 10.57% (p=0.84) of sufferers, and VPS revisions in 19.41% (p=0.13); G-tube placement after one month or longer of VPS placement resulted in 15.39% of sufferers having VPS infections (p=0.064) and 17.73% having a VPS revision (p=0.30). In sufferers with a G-tube with subsequent VPS placement inside 1-10 days, VPS an infection charges had been 8.27% (p=0.52), and VPS revision charges had been 14.39% (p=0.97); for VPS placement inside 11-30 days of G-tube placement, VPS infections had been seen in 10.82% (p=0.79), and VPS revisions had been accomplished in 14.33% (p=0.95) of sufferers; for VPS placement after one month or longer of G-tube placement, VPS an infection fee was 11.68% (p=0.52) and shunt revision fee was 16.80% (p=0.44). (Table 2)

Our outcomes display no important distinction in VPS an infection charges and VPS revision charges between same-day G-tube and VPS placement versus placement inside 1-10 days, 11-30 days, or another time after one month from each other. While earlier research have proven a VPS an infection fee of 0-30%, our examine reveals an an infection fee of 8.27%-15.39% inside 5 years [1-6]. VPS revision charges ranged from 14.33% to 19.41% inside 5 years of follow-up.

In 2020 Tyler et al. printed a retrospective evaluation taking a look at G-tube placement and VPS placement throughout the identical hospitalization. They discovered a VPS an infection fee in three out of 45 sufferers (7%) [5].

In 2017 Oterdoom et al. printed a scientific evaluate of VPS and G-tube placement. They discovered 9 related research and total discovered VPS infections in 26 out of 208 sufferers (12.5%). In addition, 137 out of 208 sufferers had VPS earlier than G-tube placement, with a VPS an infection fee of 4.4%; 55 sufferers had G-tube placement earlier than VPS, with a ensuing an infection fee of 21.8%; 16 sufferers had G-tube and VPS placement throughout the identical day, and the an infection fee was 50%. The authors concluded that G-tube placement ideally happens earlier than VPS placement however that having a VPS shouldn’t be a contraindication to G-tube placement [2].

In 2009, Kim et al. analyzed sufferers requiring a G-tube each with and with out a pre-existing VPS. Of 55 sufferers, seven (12.7%) had pre-existing shunts. The imply interval between VPS and G-tube placement was 300 days. No sufferers skilled VPS infections, and the general complication fee didn’t differ between the 2 teams [1]. Cairns et al. in 2009 reported a complete of 13 G-tubes positioned in 11 sufferers with prior VPS. One affected person had a VPS an infection 54 days after G-tube. They additionally checked out 13 sufferers with G-tube earlier than VPS placement, and 4 (30.7%) of those sufferers had VPS an infection. Overall, VPS an infection was 20.8%, and the distinction between an infection charges was not statistically important (p=0.52). Likewise, sufferers who had the 2 procedures carried out inside 10 days had the very best incidence of an infection (30%), with no statistical significance (p=0.67) [6].

Roeder et al. in 2006 examined 55 sufferers with VPS and G-tube placement. Of 55 sufferers, seven (12.5%) developed infections. The authors concluded that G-tube placement with VPS is secure and that the order of system placement doesn’t play a major function [3]. A 12 months earlier than this examine, Schulman et al. printed a retrospective single-center examine of 39 sufferers with VPS who finally required a G-tube. The time interval between VPS and G-tube placement was 2 to 564 days. Only two (5%) sufferers developed meningitis, which was on the 2- and 15-month mark after G-tube placement [4].

A 2021 systematic evaluate of G-tube and VPS placement within the pediatric inhabitants by Gerges et al. discovered 4 research involving the timing of VPS and G-tube placement, which reported inconclusive outcomes, with some examine sufferers having no infections with the concomitant placement of each gadgets, and different research displaying elevated threat of shunt an infection with prior G-tube placement [11-15].

The main limitation of this examine was its retrospective design for knowledge obtention. Furthermore, as a result of nature of the database, we had been unable to gather patient-level knowledge. Another limitation of this examine was the unavailability of radiological photos and studies. Also, the diagnostic protocol and exams carried out to evaluate diagnoses had been unavailable within the database we utilized/employed. In addition, some misidentification is inevitable in database research.

In this huge database retrospective examine, we approached the inconclusive timing between VPS and G-tube placement associated to device-related and device-placement an infection charges. Our outcomes conclude that there isn’t a important distinction in VPS an infection charges or VPS revision charges between same-day G-tube and VPS placement versus placement inside 1-10 days, 11-30 days, or another time after one month from each other. This means that these procedures are secure to carry out concurrently and that both process could not restrict the timing of the opposite.