SHUNT FAILURES AND COMPLICATIONS IN ADULTS AS RELATED TO SHUNT TYPE, DIAGNOSIS, AND THE EXPERIENCE OF THE SURGEON

DATA FROM 95 adult patients (43 males, 52 females) treated with ventri culoperitoneal shunts during an 8-year period were analyzed to investi gate risk factors in shunt surgery. All patients were seen in the auth ors' department and were grouped according to the cause or type of hyd rocephalus. The operating surgeons were divided into two categories: s pecialists and residents. The shunts were classified as single- (Orbis -Sigma) or multicomponent (Holter or Hakim) systems. Two types of unfa vorable events were recognized: complications and shunt malfunction. A total of 143 surgical procedures (implantations and revisions) were p erformed in the 95 patients; 24 patients had their shunts revised, and there were 13 complications (one fatal, five severe) resulting from t he shunt surgery. The following observations were statistically signif icant: 1) patients with normal pressure hydrocephalus had no complicat ions from shunt surgery; 2) the number of shunt malfunctions was lower in patients with intracranial hemorrhages than in the other groups; 3 ) residents performed a higher number of inadequate operations than di d specialists; and 4) the infection rate was higher among patients ope rated on by residents. The choice of shunt type, the perioperative use of antibiotics, and the degree of surgical emergency were not correla ted with complication or failure rates.