The association between race and frequent shunt failure: a single-center study.

Academic Article

Abstract

  • OBJECT: Children experiencing frequent shunt failure consume medical resources and represent a disproportionate level of morbidity in hydrocephalus care. While biological causes of frequent shunt failure may exist, this study analyzed demographic and socioeconomic patient characteristics associated with frequent shunt failure. METHODS: A survey of 294 caregivers of children with shunt-treated hydrocephalus provided demographic and socioeconomic characteristics. Children experiencing at least 10 shunt failures were considered frequent shunt-failure patients. Multivariate regression models were used to control for variables. RESULTS: Frequent shunt failure was experienced by 9.5% of the patients (28 of 294). By univariate analysis, white race (p = 0.006), etiology of hydrocephalus (p = 0.022), years-with-shunt (p < 0.0001), and surgeon (p = 0.02) were associated with frequent shunt failure. Upon multivariate analysis, white race remained the key independent factor associated with frequent shunt failure (OR 5.8, 95% CI 1.2-27.8, p = 0.027). Race acted independently from socioeconomic factors, including income, level of education, and geographic location, and clinical factors, such as etiology of hydrocephalus, surgeon, and years-with-shunt. Additionally, after multivariate analysis surgeon and years-with-shunt remained associated with frequent shunt failure (p = 0.043 and p = 0.0098, respectively), although etiology of hydrocephalus was no longer associated (p = 0.1). CONCLUSIONS: White race was the primary independent factor associated with frequent shunt failure. Because races use health care differently and the diagnosis of shunt failure is often subjective, a disparity in diagnosis and treatment has arisen. These findings call for objective criteria for the preoperative and intraoperative diagnosis of shunt failure.
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    Keywords

  • Adolescent, Cerebrospinal Fluid Shunts, Child, Child, Preschool, Databases, Factual, Equipment Failure, European Continental Ancestry Group, Female, Healthcare Disparities, Humans, Hydrocephalus, Male, Multivariate Analysis, Odds Ratio, Physician-Patient Relations, Reoperation, Research Design, Retrospective Studies, Risk Factors, Socioeconomic Factors, Surveys and Questionnaires, Time Factors, Treatment Failure, United States, Ventriculoperitoneal Shunt
  • Digital Object Identifier (doi)

    Author List

  • Naftel RP; Safiano NA; Falola M; Blount JP; Oakes WJ; Wellons JC
  • Start Page

  • 552
  • End Page

  • 557
  • Volume

  • 11
  • Issue

  • 5