Implanted Ventricular Shunts in the United States: The Billion-dollar-a-year Cost of Hydrocephalus Treatment
Tóm tắt
To characterize admissions related to ventricular shunts in the year 2000 in terms of diagnoses, procedures, socioeconomic status, and other related data.
The Nationwide Inpatient Sample database (year 2000) was analyzed retrospectively. We reviewed 7.45 million patient admissions for primary International Classification of Diseases, 9th Revision, procedure codes 023 to 0243 (ventricular shunts to peritoneal, atrial, pleural, and urinary systems for initial placement, revision, and removal); admissions listing ventriculostomy placement (code 022) were excluded from analysis.
Five thousand five hundred seventy-four admissions were identified. Admission sources primarily were routine (58.8%) and the emergency department (32.4%). Admission types primarily were elective (43.3%), emergent (33.2%), and urgent (21.9%). The top three primary diagnoses treated were shunt malfunction (40.7%), noncommunicating hydrocephalus (16.6%), and communicating hydrocephalus (13.2%). Shunt infection was the primary diagnosis in 7.2% of admissions. Age frequency of admissions was nonparametric, being highest for infants; the average stay was 8.4 ± 0.2 days (standard error range, 0–243 d). The most common procedures were ventriculoperitoneal shunt placement (43.4%) and ventricular shunt replacement (42.8%); ventricular shunt removal occurred in 7.3% of admissions, whereas ventricle-to-thorax (0.6%), ventricle-to-circulatory system (0.5%), and ventricle-to-urinary system (0.05%) shunts were rare. Average cost was $35,816 ± $810 (standard error range, $137–$814,748). Primary payers primarily were private insurers (43.8%), Medicare (26.0%), and Medicaid (24.5%). Disposition mainly was routine (78.4%, with home health care in 6.5%), and inpatient mortality was 2.7%. There was no socioeconomic disproportion in treatment with respect to average household income.
Ventricular shunts as primary procedures constitute a significant medical and economic problem.
Từ khóa
Tài liệu tham khảo
Bondurant, 1995, Epidemiology of cerebrospinal fluid shunting, Pediatr Neurosurg, 23, 254, 10.1159/000120968
, 2002, Ventricular shunting for hydrocephalus in children: Patients, procedures, surgeons and institutions in English Canada, 1989–2001, Eur J Pediatr Surg, 1, S6
Cochrane, 2003, The influence of surgical operative experience on the duration of first ventriculoperitoneal shunt function and infection, Pediatr Neurosurg, 38, 295, 10.1159/000070413
Davis, 1999, Does age or other factors influence the incidence of ventriculoperitoneal shunt infections?, Pediatr Neurosurg, 30, 253, 10.1159/000028806
Del Bigio, 1998, Epidemiology and direct economic impact of hydrocephalus: A community based study, Can J Neurol Sci, 25, 123, 10.1017/S0317167100033722
Ernst, 1980, The syndrome of long-standing Staphylococcus albus bacteremia, bacterial endocarditis and diffuse membranoproliferative glomerulonephritis complicating ventriculoatrial shunt infection: Case report and review of literature, Acta Med Iugosl, 34, 137
Gardner, 1988, Infections of mechanical cerebrospinal fluid shunts, Curr Clin Top Infect Dis, 9, 185
, 1998, Complications of a cerebrospinal fluid shunt [in Spanish], An Esp Pediatr, 48, 368
Hebb, 2001, Idiopathic normal pressure hydrocephalus: A systematic review of diagnosis and outcome, Neurosurgery, 49, 1166
Hoppe-Hirsch, 1998, Late outcome of the surgical treatment of hydrocephalus, Childs Nerv Syst, 14, 97, 10.1007/s003810050186
Iskandar, 1998, Death in shunted hydrocephalic children in the 1990s, Pediatr Neurosurg, 28, 173, 10.1159/000028644
Kay, 2000, United Kingdom and Ireland Medos Shunt Audit Group: A clinical audit of the Hakim programmable valve in patients with complex hydrocephalus, Br J Neurosurg, 14, 535, 10.1080/02688690020005545
Lam, 1997, Comparison between ventriculoatrial and ventriculoperitoneal shunting in the adult population, Br J Neurosurg, 11, 43, 10.1080/02688699746681
Mancao, 1998, Cerebrospinal fluid shunt infections in infants and children in Mobile, Alabama, Acta Paediatr, 87, 667, 10.1111/j.1651-2227.1998.tb01527.x
McGirt, 2002, Cerebrospinal fluid shunt survival and etiology of failures: A seven-year institutional experience, Pediatr Neurosurg, 36, 248, 10.1159/000058428
Olsen, 1983, Complications in the treatment of hydrocephalus in children: A comparison of ventriculoatrial and ventriculoperitoneal shunts in a 20-year material, Acta Paediatr Scand, 72, 385, 10.1111/j.1651-2227.1983.tb09733.x
Piatt, 1994, How effective are ventriculopleural shunts?, Pediatr Neurosurg, 21, 66, 10.1159/000120817
Pittman, 1992, Ventriculo-ureteral shunt without nephrectomy, Br J Neurosurg, 6, 261, 10.3109/02688699209002936
Schoeman, 2002, Long-term follow up of childhood tuberculous meningitis, Dev Med Child Neurol, 44, 522, 10.1111/j.1469-8749.2002.tb00323.x
Steiner, 2002, The healthcare cost and utilization project, Eff Clin Pract, 5, 143
Tomlinson, 1995, Complications with shunts in adults with spina bifida, BMJ, 311, 286, 10.1136/bmj.311.7000.286
Tuli, 2000, Risk factors for repeated cerebrospinal shunt failures in pediatric patients with hydrocephalus, J Neurosurg, 92, 31, 10.3171/jns.2000.92.1.0031
Upadhyaya, 1982, Results of ventriculoatrial shunt surgery for hydrocephalus using Indian shunt valve: Evaluation of intellectual performance with particular reference to computerized axial tomography, Prog Pediatr Surg, 15, 209
Willison, 1992, Ventriculopleural shunting used as a temporary diversion, Acta Neurochir (Wien), 115, 67, 10.1007/BF01400595