379 Timing of Intra-abdominal Surgery and Ventriculoperitoneal Shunt Placement in the Pediatric Population: Risk of Shunt Infection

Abstract

INTRODUCTION: Patients requiring placement of a ventriculoperitoneal (VP) shunt during the first year of life often have other comorbidities necessitating additional intra-abdominal surgeries during this first year. Some have suggested that the temporal proximity and sequence of these procedures may lead to a higher risk of subsequent shunt infection; however, data supporting such suggestions have proven limited and inconsistent. METHODS: We performed a retrospective review of all children during the first year of life who underwent both a VP shunt and an intra-abdominal procedure at a single institution between January 1, 2000 and January 1, 2018. We examined the impact of timing as well as sequence of surgeries (VP shunt first versus intra-abdominal procedure first) on shunt infection rates within 1 year of the last procedure. We additionally examined the effect of gestation age, birth weight, and placement of a prior ventricular reservoir on shunt infection. RESULTS: We identified 53 total patients undergoing both procedures with 16 having the intra-abdominal procedure first compared to 33 having the VP shunt first. Patients who had the intra-abdominal procedure first had a significantly higher rate of infection – 44% (7 of 16 patients) – compared to those who had the VP shunt first – 3% (1 of 33 patients). Further analysis failed to attribute this difference in shunt infection rate to differences in gestational age, birth weight, or time between the procedures. CONCLUSION: In our study, for patients needing both a VP shunt and a separate intra-abdominal surgery, the order of surgery greatly impacted one’s subsequent risk of VP shunt infection. These data suggest that if at all possible, the VP shunt should be performed prior to an intraabdominal procedure.