Comparative effectiveness of surgical treatments for pediatric hydrocephalus

I. Wen Pan, Dominic A. Harris, Thomas G. Luerssen, Sandi K. Lam

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Pediatric hydrocephalus represents a high health care burden in the United States (US). Surgery is the mainstay of treatment. OBJECTIVE: To performa comparative effectiveness analysis for endoscopic third ventriculostomy (ETV) and cerebrospinal fluid shunt placement inpediatric hydrocephaluspatients in the US using a large administrative claims database through the application of propensity scores matching. METHODS: The MarketScan ® database (Truven Health Analytics, Atlanta, Georgia) 2003 to 2011 was used. Patients 19 yr or younger at first occurrence of ETV or shunt during the study period were included. The study outcome, surgery failure, was defined as further surgical treatment for hydrocephalus subsequent to initial ETV or shunt procedure. Age, etiology of hydrocephalus, and history of shunt were used to create matched samples for the ETV and shunt cohorts. Kaplan-Meier survival curves, stratified log-rank test, and Cox proportional-hazard models were used to analyze samples. RESULTS: There were 3231 eligible cases (478 ETV; 2753 shunt). Propensity scores matching produced 455 balanced pairs. For matched samples, 326 of 455 (72%) pairswere concordant, while 129 pairs were discordant in surgery outcomes within 3 mo. Among discordant pairs, ETV patientsweremore likely to experience surgery failure compared to patients receiving shunt (relative risk = 1.4, P value = .011). Furthermore, patients' age < 1 yr had lower ETV success rates than those with shunt (P value = .009). No similar pattern was found in patients' age ≥ 1 yr. CONCLUSION: There was no significant effect on time to failure between patients undergoing ETV and shunt, except in infants' age <1 yr.

Original languageEnglish (US)
Pages (from-to)480-487
Number of pages8
JournalClinical neurosurgery
Volume83
Issue number3
DOIs
StatePublished - Jan 1 2018

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Keywords

  • Cerebrospinal fluid shunt
  • Endoscopic third ventriculostomy
  • Hydrocephalus
  • Pediatric
  • Propensity scores matching
  • Ventriculoperitoneal shunt

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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