Authors: Jason Scott Hauptman, MD PhD; John Kestle, MD; Jay Riva-Cambrin, MD; Sam Browd, MD, PhD; Abhaya Kulkarni, MD, PhD; Curtis Rozelle, MD, PhD; William Whitehead; Robert Naftel, MD; Jonathan Pindrik, MD; David Limbrick, MD, PhD; James Drake, MD; Jay Wellons (Seattle, WA)

Introduction: Little is understood about the subgroup of children who undergo multiple shunt revisions in a short period of time. The goal of this study is to identify the children in the registry who have experienced rapid shunt failures (<30 days after shunt operation) and compare them to a matched cohort. Methods: We limited this analysis to subjects in the HCRN cohort who have had a shunt placement in the registry and have had at least one subsequent shunt revision prior to 1/1/18. A multivariate logistic regression model was used to determine if there is a difference between procedures that failed within 30 days (fast failure), within 7 days (ultra-fast failure) and procedures that failed after 30 days. We examined the effects of etiology, age at initial shunt placement, presence of slit-ventricles on imaging at revision, ventricular enlargement on imaging at revision, and history of fast failures. Results: A total of 3,310 shunt operations were evaluated in the clean cohort, of which 1,121 were primary shunt placements and 2,189 were shunt revisions. For primary shunt placements, the mean age at the time of shunt placement was 0.3 years [0.1, 1.2]. The etiologies of hydrocephalus included post-IVH secondary to prematurity(24.1%), myelomeningocele(16.9%), aqueductal stenosis(8.6%), and other(50.5%). For revisions, the mean age at the time of revision was1.8 years [0.6, 4.9]. Of these patients, 43 (2.0%) were identified by the surgeon as having slit ventricle syndrome, and1222 (55.8%) had ventricular enlargement noted at the time of failure. Multivariate logistic regression revealed that etiology was an independent predictor of fast failures (p<0.001) and both age at the time of procedure (p=0.01) and etiology (p=0.009) were predictors of ultra-fast failures. Conclusion: Age at shunt placement and etiology of hydrocephalus are significant predictors of rapid shunt failures in children.