Shunt insertion in the summer: is it safe?

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Publication Type Journal Article
School or College School of Medicine
Department Neurosurgery
Creator Kestle, John R. W.
Other Author Cochrane, D. Douglas; Drake, James M.
Title Shunt insertion in the summer: is it safe?
Date 2006
Description Object. The potential for increased complications related to the arrival of new residents in July each year has not previously been demonstrated in the neurosurgical literature. The authors investigated this phenomenon in children undergoing cerebrospinal fluid shunt surgery. Methods. Data were obtained from a multicenter hydrocephalus clinical trials database and from hospital admission records in English-speaking Canada. Data pertaining to patients treated in July and August were compared with those pertaining to patients treated during the remainder of the year. The incidence of shunt failure, shunt infection, neurological deficits, wound infection, technical errors, and death were compared using a chi-square test for categorical outcomes, means for continuous outcomes, and survival analysis for time-dependent outcomes. In the hydrocephalus clinical trials database, 138 of 737 patients were treated in July and August. The median duration of shunt lifespan (hereafter referred to as "shunt survival") was 1.7 years for patients treated during the summer months and 2.4 years for those treated throughout the rest of the year (p = 0.10); for shunt infection the figures were 13.8 and 8.8% (p = 0.08) of the total number of cases, and for wound dehiscence they were 2.9 and 0.7% (p = 0.05), respectively. When all shunt procedures were included, an examination of shunt survival and infection incidence rates recorded in the Canadian Hospital Discharge Database seemed to imply a significant advantage to having surgery between September and June (log-rank statistic = 7.10, p = 0.008). Conclusions. The data suggest a "July effect" on some outcomes related to shunt surgery, but the effect was small. Nonetheless, the potential morbidity of shunt failure, infection, and the cost of treatment indicate that continued vigilance and appropriate supervision of new staff by attending surgeons is warranted.
Type Text
Publisher American Association of Neurological Surgeons (AANS)
Volume 105
Issue 3 Suppl
First Page 165
Last Page 168
Subject Ventriculoperitoneal shunt; July effect; Complication; Shunt insertion
Subject LCSH Hydrocephalus in children; Pediatric neurology; Cerebrospinal fluid shunts; Residents (Medicine)
Language eng
Bibliographic Citation Kestle, J. R. W., Cochrane, D. D., & Drake, J. M. (2006). Shunt insertion in the summer: is it safe? Journal of Neurosurgery, 105(3 Suppl), 165-8.
Rights Management (c) American Association of Neurological Surgeons
Format Medium application/pdf
Format Extent 193,330 bytes
Identifier ir-main,13206
ARK ark:/87278/s60c5cvz
Setname ir_uspace
Date Created 2012-06-13
Date Modified 2021-05-06
ID 702549
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