Authors: Ashley Marie Sablich
Patients who receive both ventriculoperitoneal (VP) shunts and gastrostomy tubes (G-tubes) may have an increased risk of infection, though there is no sequential recommendation for placing G-tubes when a VP shunt is also required. The aim of this study is to determine if sequence or timing affects infection rates between VP shunt placements and G-tube insertions.Methods: Pediatric patients (Nf5,998) with documented G-tubes and VP shunt insertions, based on Current Procedural Terminology (CPT) codes, from the American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) database from 2016-2019 were included. Data were analyzed using Fishers exact and logistic regression. The primary outcome was infection (including superficial incisional SSI, deep incisional SSI, organ/space SSI, and sepsis) and primary predictor was timing of G-tube insertion, controlling for age.
The cohort had a median age of 5.1 months (Q1=1.8, Q3=40.4), 2,711 (45.2%) were female, 942 (17.34%) were Hispanic, 3,574 (71.5%) were White, 1,207 (24.1%) were Black, and 219 (4.4%) were neither White nor Black. Infections occurred in 242 (4.0%) patients. Patients who had G-tubes placed >30 days prior to VP shunts had high odds of infection (OR=1.97 [95%CI: 1.35-2.87]; P < 0.02). There was no difference in infection between patients who received both VP shunts and G-tubes within 14 or 30 days. Furthermore, the sequence of the procedures did not matter, when performed within 14 or 30 days of each other, as they were not associated with increased rate of infection.
Previous literature has debated which risk factors in VP shunt and G-tube placements are significant. Our results demonstrate a G-tube placed greater than 30 days prior to a VP shunt carries a high odds of infection, highlighting a preoperative risk factor of infection for VP shunt insertion.