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Factors Predicting Ventriculostomy Revision at a Large Academic Medical Center
- 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.
- Subjects :
- Male
Reoperation
Ventriculostomy
medicine.medical_specialty
Multivariate statistics
Point-of-Care Systems
medicine.medical_treatment
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
medicine
Foramen
Humans
Retrospective Studies
business.industry
Univariate
Odds ratio
Middle Aged
Subarachnoid Hemorrhage
Surgery
Catheter
030220 oncology & carcinogenesis
Drainage
Equipment Failure
Female
Neurology (clinical)
business
Complication
Intracranial Hemorrhages
030217 neurology & neurosurgery
Hydrocephalus
External ventricular drain
Subjects
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