Gastrostomy tube placement increases the risk of ventriculoperitoneal shunt infection: a multiinstitutional study

Safety Study of Percutaneous Gastroscopic Gastrostomy in Patients After Ventriculoperitoneal Shunt

OBJECTIVE

To evaluate the safety study of percutaneous gastroscopic gastrostomy in patients after ventriculoperitoneal shunt.

METHODS

We conducted a retrospective analysis of neurosurgical patients who underwent VPS and PEG at our hospital between January 2012 and November 2023. Patients were divided into 2 groups: VPS group and VPS followed by PEG gruop. Patients received routine antibiotic prophylaxis before the procedure, continued for 48 hours. Follow-up included monitoring immediate complications, particularly wound infection, intracranial infection, neurologic status deterioration, and shunt dysfunction. Routine follow-up visits were conducted post-discharge.

RESULTS

In the VPS group (n = 778), the incidence of intracranial infection was 3.08%. Among patients with PEG after VPS, the time interval between procedures ranged from 13 to 685 days. The mean follow-up period was 22 (1-77) months, with no deaths or further complications.

CONCLUSION

Performing PEG more than 13 days after VPS does not significantly increase the risk of intracranial infections or PEG-associated infections, making it a relatively safe procedure.

Gastrostomy Sequence With Ventriculoperitoneal Shunting-Does It Matter?

BACKGROUND

Neurological injury requiring ventriculoperitoneal shunt (VPS) placement often necessitates gastrostomy for nutritional support. The sequence of these procedures is debated over concerns for shunt infection and displacement requiring revisional surgery as a consequence of gastrostomy.

OBJECTIVE

To determine the optimal sequence of VPS shunt and gastrostomy tube placement in adults.

METHODS

In an all-payer database, adult patients undergoing gastrostomy and VPS placement were identified within 15 days between January 2010 and October 2021. Patients were categorized as receiving gastrostomy before, on the same day as, or after shunt placement. The primary outcomes of this study were rates of revision and infection. All outcomes were evaluated within 30 months after index shunting.

RESULTS

In total, 3015 patients were identified as undergoing VPS and gastrostomy procedures within 15 days. After a 1:1:1 match, 1080 patient records were analyzed. Revision rates at 30 months were significantly lower among patients who received VPS and gastrostomy procedures on the same day compared with gastrostomy after VPS (odds ratio [OR] 0.61, 95% CI 0.39-0.96). In addition, patients who received gastrostomy before VPS compared with those after had lower revision rates (OR 0.61, 95% CI 0.39-0.96) and infection (OR 0.46, 95% CI 0.21-0.99). No significant differences were noted in mechanical complication or shunt displacement rates.

CONCLUSION

Patients requiring VPS and gastrostomy may benefit from undergoing both procedures concurrently or with gastrostomy before VPS placement, secondary to lower revision rates. Patients undergoing gastrostomy before VPS have the added benefit of decreased infection rates.

Ventriculoperitoneal shunt management in children undergoing liver transplantation

There is a lack of data to guide neurosurgeons on the management of ventriculoperitoneal shunts (VPS) in patients undergoing abdominal transplant operations. We present the cases of two pediatric patients with VPS undergoing liver transplantation who were successfully managed with externalization of the VPS at time of transplantation, with subsequent re-internalization once cleared by the transplant surgery team. We present this as an effective management strategy in patients undergoing liver transplantation.

Optimal timing and sequence of ventriculoperitoneal shunt and gastrostomy placement

Background: The optimal timing of ventriculoperitoneal shunt (VPS) and gastrostomy placement, relative to the safety of simultaneous versus staged surgery, has not been clearly delineated in the literature.Objective: To study the optimal inter-procedural timing relative to distal VPS infection and pertinent reoperation.Methods: A fifteen-year, retrospective, single-center study was conducted on adults undergoing VPS and gastrostomy within 30-days. Patients were grouped according to inter-procedural interval: 0-24 hr (immediate), 24 hr-7 days (early), and 7-30 days (delayed). The primary endpoint of the study was VPS infection and distal shunt complications requiring reoperation. Potential predictors of the primary end point (baseline cohort characteristics, procedural factors) were examined with standard statistical methods.Results: A total of 188 patients met inclusion criteria. The average interval between procedures was 7 ± 6 days, with 43.1% undergoing VPS prior to gastrostomy. Primary endpoint was encountered in 5 patients (2.7%): 1 (5.9%) of 17 patients undergoing immediate placement, 3 (2.8%) of 107 with early placement, and 1 (1.6%) of 64 with delayed placement. Although not statistically significant, 3.7% of patients undergoing VPS first had the primary endpoint, compared to 1.9% of those with gastrostomy. There were no statistically significant associations between the primary outcome and peri-operative CSF counts, gastrostomy modality, hydrocephalus etiology, chronic steroid use, or extended antibiotic administration.Conclusion: Although the low overall event rate in this cohort precludes definitive determination regarding differential safety, the data generally support a practice of performing the procedures >24-hours apart, with placement of gastrostomy prior to VPS.