ArticleNeurocritical care2026
The Optimal Timing of Ventriculo-Peritoneal Shunting and Gastrostomy Tube Placement: A Nationwide Retrospective Analysis.
Article in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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9 authors.
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Abstract
BACKGROUND/
objectivesThe transition of the neurologically injured patient from the intensive care unit (ICU) environment toward recovery often requires placement of a ventriculo-peritoneal shunt (VPS) and a gastrostomy tube (g-tube). Prior work has demonstrated a significant association between g-tube placement and shunt infection, however, both procedures are typically performed during the same hospitalization. Thus, there remains a question regarding the optimal timing of g-tube relative to VPS placement and the risk of subsequent complications. The objective of this study is to examine the risk of complications on the basis of relative timing of VPS and g-tube placement.
methodsPatients admitted for intracranial hemorrhage who underwent both VPS and g-tube placement within 10 days of each other were retrospectively identified in the Nationwide Readmissions Database from 2016 to 2022. Patients were divided into three groups: VPS > 1 day before g-tube, g-tube > 1 day before VPS, and both procedures within 1 day. Primary outcomes were inpatient shunt infection or revision and delayed infection or revision within 180-days post-discharge.
resultsOverall, 3334 patients met the inclusion criteria. The most common period for the procedures to occur was within 24 h of each other. Excluding patients who received both VPS and g-tube within 1 day of separation (n = 530, 15.9%), 1254 (44.7%) received VPS first while 1550 (55.3%) received VPS second. Patients who received VPS first were significantly more likely to experience inpatient central nervous system (CNS) infection (10.5% vs. 9.5%, adjusted odds ratio (aOR): 1.52; 95% confidence interval (CI) 1.10-2.10; p = 0.012) and shunt failure requiring revision (6.8% vs. 4.9%, aOR 1.57 [95%CI 1.03-2.41], p = 0.038). Compared with the g-tube first group, those who received VPS within 1 day of g-tube had no significant differences in CNS infection or shunt failure (p > 0.05). There were no differences in delayed complications between groups within 180 days post-discharge (all p > 0.05).
conclusionsWhile our results are primarily hypothesis generating, in this nationwide analysis, we demonstrate that g-tube placement before or within 24 h of VPS is associated with significantly lower odds of shunt failure or infection.
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