Comparison of postoperative outcomes following endoscopic third ventriculostomy or shunt in a propensity-score matched pediatric cohort

Introduction: Thirty-day readmission and return to the operating room are widely used metrics of surgical quality. This study compares short-term outcomes following endoscopic third ventriculostomy (ETV) and CSF shunt surgery in a large multicenter database.

Methods: Data regarding patients undergoing ETV or shunt insertion were extracted from the National Surgical Quality Improvement Program – Pediatric for 2013-2020. Patients were stratified into three age groups: ≤6 months (N = 5906), between 6 months-2 years (N = 2364), and ≥2 years (N = 4408). Preoperative characteristics were compared before and after propensity-score matching. Post-match outcome comparison included CNS complications, mortality, length of stay, readmission, and reinterventions.

Results: There were 10135 shunt operations and 2543 ETVs. Pre-match, children undergoing shunt insertion were younger and lower weight, and they experienced more seizures across age categories. Among patients ≤6 months, ETV had higher rates of seizure (ETV 6.3% vs shunt 0.4%, p< 0.001), readmission (ETV 15.7% vs shunt 6.1%, p< 0.001), and reintervention (ETV 17.4% vs shunt 4.8%, p< 0.001). Among patients between 6 months and 2 years, ETV exhibited higher rates of seizure (ETV 3.3% vs shunt 1.0%, p=0.01), readmission (ETV 14.9% vs shunt 7.8%, p< 0.001), and reintervention (ETV 13.0% vs shunt 5.4%, p< 0.001). Among older patients, ETV was associated with decreased median length of stay (ETV 3 days, IQR 1-6 days vs shunt 3 days, IQR 2-8 days, p=0.0019) and less frequent mortality (ETV 0.4% vs shunt 1.5%, p=0.007).

Conclusion : Outcomes following shunt surgery and ETV in matched patients appear to be age-dependent. Younger patients undergoing ETV encountered more short-term complications than matched patients undergoing shunt insertion.