Survival Status and Predictors of Mortality Among Children Who Underwent Ventriculoperitoneal Shunt Surgery at Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia, January 2020 - December 2024

Abstract

Background: Ventricul opertoneal (VP) shunt placement remains the most widely used surgical treatment for childhood hydrocephalus worldwide. However, in low-resource settings such as Ethiopia, children who have undergone this procedure often face unacceptable high rates of complications and mortality. Despite being a common neurological intervention at our center, we still have a limited understanding of actual survival patterns and the main factors driving poor outcomes in these vulnerable groups. This study evaluated survival after VP shunt surgery and identified key predictors of death among pediatric patients at Ayder Comprehensive Specialized Hospital. Methods: A retrospective follow-up study reviewed the medical records of 573 children aged < 18 years at Ayder Comprehensive Specialized Hospital. A systematic random sampling method was used. The collected data were reviewed and entered into Epidata 4.7, and then exported to Stata 14 for analysis. Survival analysis methods, including the life-table method, Kaplan-Meier curves, and the log-rank test, were employed in this study. Both bivariate and multivariable analyses were performed. Schoenfeld residual was tested. Variables with P< 0.25 were considered significant, and adjusted hazard ratios with 95% confidence intervals were reported. Result: This study found the mortality proportion of the study was 25.6% among children who underwent ventriculoperitoneal (VP) shunt surgery at ACSH between 2020 and 2024, with a median survival time of 19 months. The incidence rate of death was 0.0526 per person-year (95% CI: 0.044-0.062), which corresponds to approximately 52.6 deaths per 1,000 person-years (95% CI: 45-62). Key predictors of increased mortality included, communicating hydrocephalus(AHR: 1.70, 95% CI: 1.10-2.65), emergency surgery AHR: 1.80, 95% CI: 1.25-2.62), revised shunt, AHR: 1.40, 95% CI: 1.01-2.22), and prolonged antibiotics after surgery 1.80, AHR: 95% CI: 1.01- 2.15). Conclusion: The proportion of mortality 25.6%. Key predictors of VP shunt surgery in children included communicating hydrocephalus, type of surgery, revised shunt, and prolonged antibiotic use. Identifying high-risk patients early and improving perioperative management are essential steps to boost survival rates.