Preoperative nomogram predicting ventriculoperitoneal shunt longevity after initial shunt failure

Dongsheng Liu; Qiheng He; Jianxing Niu; Liangliang Li; Ronghua Geng; Tianqing Cao; Xiaosong Wang; Zeping Lv; Jianghong He; Jizong Zhao; Guoqiang Chen; Yi Yang

doi:10.3389/fneur.2023.1285604

Preoperative nomogram predicting ventriculoperitoneal shunt longevity after initial shunt failure

Front Neurol. 2024 Jan 12:14:1285604. doi: 10.3389/fneur.2023.1285604. eCollection 2023.

Authors

Dongsheng Liu^#^{1

2}, Qiheng He^#², Jianxing Niu¹, Liangliang Li¹, Ronghua Geng¹, Tianqing Cao², Xiaosong Wang¹, Zeping Lv^{3

4

5}, Jianghong He², Jizong Zhao², Guoqiang Chen¹, Yi Yang^{2

3

4

5}

Affiliations

¹ Department of Neurosurgery, Civil Aviation General Hospital, Beijing, China.
² Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
³ Department of Neurosurgery, National Research Center for Rehabilitation Technical Aids, Beijing, China.
⁴ Department of Neurosurgery, Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, Beijing, China.
⁵ Key Laboratory of Neuro-functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Beijing, China.

^# Contributed equally.

Abstract

Background and objectives: Initial shunt failure following ventriculoperitoneal (VP) shunt surgery has a significant impact on the working time of the shunt. However, there are few studies regarding factors affecting VP shunt longevity. Hence, in this study, we aimed to build a nomogram to predict the longevity of the replacement VP shunt in patients with initial shunt failure.

Methods: From 2011 to 2021, 142 patients with initial VP failure who underwent VP shunt revision were enrolled and relevant clinical and demographic factors were analyzed. Univariate and multivariate Cox proportional hazard regression models were used to choose predictors, and a nomogram was constructed using nine independent prognostic variables: sex, age, hydrocephalus type, intensive care unit admission, tracheostomy, decompressive craniectomy, craniotomy, lumbar cisterna drainage, and ventricular drainage. The prediction models' discrimination, accuracy, calibration, and clinical value were evaluated using Harrell's C-index, a calibration plot, and decision curve analysis.

Results: At 1 month, 3 months, and 5 years, the nomogram's C-index was 0.680, 0.708, and 0.694, respectively. The nomogram's calibration plot provided a good fit for the overall prediction over the course of 1 year. Decision curve analysis predicted that 1-3 months after surgery will yield good net benefits between 30 and 50% probability thresholds.

Conclusion: A preoperative nomogram may be an effective tool for assessing VP shunt longevity after initial VP shunt placement.

Keywords: VP shunt longevity; VP shunt surgery; cox survival regression analysis; initial shunt failure; preoperative nomogram.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was supported by the National Natural Science Foundation of China (no. 81600919), Beijing Municipal Science and Technology Commission (No. Z161100000516165; no. Z171100001017162), Beijing Nova Program (Z181100006218050), and the Key Laboratory and Engineering Center in the Field of Rehabilitation of the Ministry of Civil Affairs (2022GKZS0003, 2022GKZS0004, 2022GKZS0005).