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Factors Predicting Ventriculostomy Revision at a Large Academic Medical Center

Authors :
Svetlana Kvint
Kalil G. Abdullah
Neil R. Malhotra
David Kung
Marc Branche
Gregory Glauser
Brendan J McShane
Ashwin G. Ramayya
H. Isaac Chen
Ali K. Ozturk
Vivek P. Buch
Saurabh Sinha
Source :
World Neurosurgery. 123:e509-e514
Publication Year :
2019
Publisher :
Elsevier BV, 2019.

Abstract

Freehand bedside ventriculostomy placement can result in catheter malfunction requiring a revision procedure and cause significant patient morbidity. We performed a single-center retrospective review to assess factors related to this complication.Using an administrative database and chart review, we identified 101 first-time external ventricular drain placements performed at the bedside. We collected data regarding demographics, medical comorbidities, complications, and catheter tip location. We performed univariate and multivariate statistical analyses using MATLAB. We corrected for multiple comparisons using the false discovery rate (FDR) procedure.Multivariate regression analyses revealed that revision procedures were more likely to occur after drain blockage (odds ratio [OR] 17.9) and hemorrhage (OR 10.3, FDR-corrected P values0.01, 0.05, respectively). Drain blockage was less frequent after placement in an "optimal location" (ipsilateral ventricle or near foramen of Monroe; OR 0.09, P = 0.009, FDR-corrected P0.03) but was more likely to occur after placement in third ventricle (post-hoc P values0.015). Primary diagnoses included subarachnoid hemorrhage (n = 30, 29.7%), intraparenchymal hemorrhage with intraventricular extravasation (n = 24, 23.7%), tumor (n = 20, 19.8%), and trauma (n = 17, 16.8%). Most common complications included drain blockage (n = 12, 11.8%) and hemorrhage (n = 8, 7.9%). In total, 16 patients underwent at least 1 revision procedure (15.8%).Bedside external ventricular drain placement is associated with a 15% rate of revision, that typically occurred after drain blockage and postprocedure hemorrhage. Optimal placement within the ipsilateral frontal horn or foramen of Monroe was associated with a reduced rate of drain blockage.

Details

ISSN :
18788750
Volume :
123
Database :
OpenAIRE
Journal :
World Neurosurgery
Accession number :
edsair.doi.dedup.....8bd7acd695a256c24f0934cad0f9ba80
Full Text :
https://doi.org/10.1016/j.wneu.2018.11.196