Authors: Brandon G. Rocque, MD, MS, FAANS
Studies of pediatric hydrocephalus historically focus on ventriculoperitoneal (VP) shunt revision as the outcome to be avoided. However, there is no known way to prevent shunt failure. Therefore, any study of children with shunts will include shunt revisions. If disparities in the rate of shunt revision exist, based on sex or race, these disparities would be a potential focus for investigation.Methods: We conducted a systematic review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Pub-med and Embase databases were searched using the terms Cerebrospinal Fluid Shunts AND reoperation, for all articles published through May 2021. Titles and abstracts were screened to identify articles that studied VP shunt revision rates. Full texts were reviewed to identify those articles which included an analysis of revision rate by sex and/or by race. Descriptive results are presented.
Of 1035 articles identified, 110 articles were reviewed in full. Only 11 articles reported results by sex or race. Articles reported different outcomes (e.g. 1-year failure rate, time to first failure, number of failures, etc.) so meta-analysis was not possible. Eight articles commented on the difference in outcomes between male and female subjects; none were statistically significant. In 5 (63%) articles, girls had slightly more shunt revisions than boys. Nine articles analyzed race as a variable associated with adverse outcome. In seven studies (78%), white children had more shunt revisions than minority children (none showed statistical significance).
There is little published data on the effect of sex or race on shunt revision in the United States. In the majority of studies that did report on race, white children had slightly more revisions than minority children. Given that there are known differences in published outcomes, with minority children faring worse than white children with hydrocephalus, this disparity is an important area for future study.