101. Rates Of In-Hospital Failure For Endoscopic Third Ventriculostomy (ETV) Compared To Shunting In Post-Hemorrhagic Hydrocephalus Of Prematurity (PHHP)
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Authors: Evan Luther, MD; David McCarthy, MSc; Shaina Sedighim; Toba Niazi, MD (Miami, FL)
ETV has shown promise in treating PHHP in an effort to prevent lifelong shunt dependence in neonates. However, there is limited data regarding in-hospital failure rates and the factors contributing to their potential failure.
We performed a retrospective analysis of the Nationwide Inpatient Sample (NIS) between 2004-2014. Patients < 1 year of age with an ICD-9-CM diagnosis code indicating IVH of prematurity (772.1x) and an ICD-9-CM procedure code indicating an ETV (02.2 and 02.22) or a shunt (02.3x) were included. Univariate analysis was used to test covariates predictive of in-hospital failure, time to failure and crossover to shunt or ETV after failure. Interaction and confounding were assessed through stratification and relevant expansion covariates. Factors predictive in univariate analysis (p<0.20) were entered into a backwards elimination multivariate logistic regression analysis. P-values of ≤0.05 were considered statistically significant.
A total of 9,325 patients with PHHP were identified in the NIS from 2004-2014. Patients shunted as an initial treatment had significantly decreased risk of failure compared to those who underwent an ETV (OR .366, 95% CI .318 to .422, p < 0.0001). There were no significant differences in time to failure between the two groups. ~92% of ETVs that failed were shunted after the first failure and those who were shunted as an initial treatment were much less likely to undergo ETV if they failed (OR 1.56, 95% CI .12 to .202, p <0.0001). Both ETV and shunts were more likely to fail in patients with respiratory distress syndrome and perinatal infections were predictive of shunt failure but not ETV. Grade of IVH was not predictive of failure in either group.
Although ETV can be effective in treating PHHP, it has a much higher initial failure rate than shunts, and should thus be chosen based on a multifactorial approach.