TY - JOUR
T1 - Comparative effectiveness of surgical treatments for pediatric hydrocephalus
AU - Pan, I. Wen
AU - Harris, Dominic A.
AU - Luerssen, Thomas G.
AU - Lam, Sandi K.
N1 - Publisher Copyright:
© 2017 by the Congress of Neurological Surgeons.
PY - 2018/9/1
Y1 - 2018/9/1
N2 - 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.
AB - 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.
KW - Cerebrospinal fluid shunt
KW - Endoscopic third ventriculostomy
KW - Hydrocephalus
KW - Pediatric
KW - Propensity scores matching
KW - Ventriculoperitoneal shunt
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U2 - 10.1093/neuros/nyx440
DO - 10.1093/neuros/nyx440
M3 - Article
C2 - 28945918
AN - SCOPUS:85053242654
SN - 0148-396X
VL - 83
SP - 480
EP - 487
JO - Clinical Neurosurgery
JF - Clinical Neurosurgery
IS - 3
ER -