Evidence-Based Perioperative Protocol for Ventriculoperitoneal Shunt Infection Reduction at a Single Institution

Abstract

Ventriculoperitoneal shunt infections are common and result in significant morbidity, mortality, and health care expenditure. The objective of this study was to create an evidence-based perioperative shunt infection prevention protocol and analyze its efficacy by comparing the incidence of shunt infection before and after implementation at one institution. A perioperative ventriculoperitoneal shunt surgery protocol was developed based on a systematic literature review with the goal of reducing infection rates. Patients undergoing shunt surgery at Upstate Medical University Hospital, from before and after implantation of the perioperative shunt surgery protocol, were retrospectively analyzed and compared. Retrospective data collection included shunt infection incidence as a primary outcome and clinical features of patients from both cohorts. The pre-protocol and post-protocol cohorts included 226 and 285 patients, respectively. Twenty (8.8%) pre-protocol shunt infections and 16 (5.6%) post-protocol shunt infections were identified (P= 0.156). The relative risk of shunt infection between cohorts was 0.97 (95% confidence interval: 0.92-1.02). Although shunt infection rates pre-protocol and post-protocol were not significantly different, a trend toward fewer shunt infections was observed with protocol implementation. Suboptimal compliance at our institution may have limited accurate assessment of protocol efficacy. Similar future studies may benefit from objectively assessing protocol compliance.