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Ventriculoperitoneal Shunt Management Strategies During Emergency Abdominal Surgery: A Retrospective Cohort Analysis
Anum Iqbal
*1, Mohamed Elgohary
2, Ricardo C. Armas
1, Abdelrahman M. Hamouda
2, Myung Park
1, Roderick Davis
1, Benjamin Elder
2, Beth Ballinger
1, Erica Loomis
1, Michelle Junker
11Department of Surgery, Division of Trauma, Critical Care, and General Surgery, Mayo clinic, Rochester, MN; 2Department of Neurosurgery, Mayo Clinic Rochester, Rochester, MN
Objectives:Emergency abdominal surgical interventions may risk infection of previously implanted ventriculoperitoneal shunts (VPS), yet evidence guiding intraoperative shunt management in adults is limited. We evaluated postoperative shunt-related infection among adults with VPS undergoing emergency general surgery (EGS) interventions, specifically comparing maintained versus externalized shunts across wound classes.
Methods:We performed a single-institution 25-year (2000 to 2025) retrospective cohort study of adults (≥18 years) with VPS undergoing EGS. Patients were identified using institutional databases; those lacking Minnesota research authorization were excluded. Data collected included demographics, operative diagnosis, VPS valve type, surgical procedure, wound class, antibiotic therapy, and intraoperative VPS management (maintained, externalized, or shunt removal) at the time of the index intervention. Primary outcome was VPS infection within 30 days, stratified by CDC surgical wound class independently documented at the time of index operative intervention. Descriptive statistical analyses were performed using BlueSky Statistics.
Results:Overall, 5230 patients were identified; 57 EGS interventions were performed after VPS. Median age was 60 years (IQR 38-73), 66.7% male. The most common EGS diagnoses were biliary (43.9%), small bowel (17.5%) and appendiceal (15.8%). Hollow viscous perforation was present in 5.3%. Minimally invasive approach was used for 49.1% of cases. The most common wound class was II (47.4%) followed by III (28.1%) and IV (17.5%).
VPS was maintained intraoperatively in 87.5% and externalized in 12.5%. Valve types were programmable in 52.6%. Antibiotic-impregnated catheters were present in 66.7% of patients. Shunt infection occurred in 2 patients (3.5%) within 30 days. The first occurred following laparoscopic appendectomy (wound class III, day 2); VPS was removed followed by eventual replacement after completing antibiotic therapy. The second infection was following PEG placement (wound class II, day 4); VPS was removed, and temporary ventricular drainage was established. This patient suffered an unrelated mortality prior to reimplantation.
Conclusion:Our study suggests that in adults with a VPS, maintaining the shunt during EGS cases can be associated with a low observed infection rate. This approach may avoid additional invasive interventions. Prospective studies are needed to further evaluate the safety and generalizability of this strategy.
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