Back to Search
Start Over
Laparoscopically Assisted Ventriculoperitoneal Shunt Placement Is not Cost-Effective nor Preventive for Distal Shunt Malfunction
- Source :
- World Neurosurgery. 137:e308-e314
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- Background Laparoscopy for ventriculoperitoneal shunt creation might offer smaller incisions and more reliable placement. We assessed the reliability and cost-effectiveness of this technique compared with mini-laparotomy shunt placement. Methods All patients undergoing ventriculoperitoneal shunt creation between November 2013 and September 2017 at a single academic institution were evaluated. Individual cases were assessed for the use of laparoscopy for peritoneal shunt placement (laparoscopy) versus mini-laparotomy for peritoneal shunt placement (open). The direct hospital costs for the laparoscopy and open groups were compared for elective shunt placement from the Vizient database. These direct costs were the proportion of the admission cost attributed to surgery. The primary endpoints included costs and revision of the peritoneal catheter within 12 months of the index procedure. Results A total of 68 patients met the inclusion criteria. Most cases (n = 40; 58.8%) had been performed with laparoscopy, with 28 performed using an open peritoneal approach. Three patients had required ≥1 distal shunt revision: 2 laparoscopy patients (5.0%; 1 had required a second revision) and 1 open patient (3.6%). No statistically significant differences were found for the patients requiring distal shunt revision between the 2 groups (P = 1.000; Fisher's exact test). The direct cost ($9461) of ventriculoperitoneal shunt creation with laparoscopy was greater than that with an open approach ($8247; P = 0.033). Conclusions Both laparoscopy and open peritoneal shunt creation are safe procedures, with a 12-month distal revision rate in the present series of ~4%. Laparoscopy provided no relative improvement in safety or complication avoidance but had resulted in a mean increase in costs of >$1200 per patient.
- Subjects :
- Adult
Male
Reoperation
Shunt placement
medicine.medical_specialty
Cost effectiveness
Cost-Benefit Analysis
Ventriculoperitoneal Shunt
03 medical and health sciences
Indirect costs
Postoperative Complications
0302 clinical medicine
medicine
Humans
Laparoscopy
Aged
Laparotomy
medicine.diagnostic_test
business.industry
Middle Aged
medicine.disease
Shunt (medical)
Hydrocephalus
Surgery
Exact test
030220 oncology & carcinogenesis
Equipment Failure
Female
Neurology (clinical)
Complication
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 18788750
- Volume :
- 137
- Database :
- OpenAIRE
- Journal :
- World Neurosurgery
- Accession number :
- edsair.doi.dedup.....13b2f7023713905a06fbf498f9d9676c