Risk factors for postoperative infection in patients with post-traumatic hydrocephalus after ventriculoperitoneal shunt

LI Guang-liang; WANG Fang-yi; LI Liang; ZHANG Yi

doi:10.13798/j.issn.1009-153X.2023.09.008

Abstract：Objective To investigate the risk factors of postoperative infection in patients with post-traumatic hydrocephalus(PTH)after ventriculoperitoneal shunt(VPS).Methods The clinical data of 250 patients with PTH treated with VPS from May 2015 to May 2020 were retrospectively analyzed.The patients were followed up for 1 year to evaluate the infection status,including VPS-related intracranial infection,incision infection,and abdominal infection.Multivariate logistic regression model was used to analyze the risk factors of postoperative infection,and a nomogram model was constructed.Receiver operating characteristic(ROC)curve was used to evaluate the predictive efficacy of the nomogram model.Results Of these 250 patients,32 patients(12.8%)suffered from postoperative infection,of which 8 patients were intraventricular infection,14 intraperitoneal infection,3 intraperitoneal pseudocysts,and 7 shunt tube obstruction caused by high levels of protein and cellulose in cerebrospinal fluid.Sixteen patients were infected with Staphylococcus epidermidis,7 with Staphylococcus aureus,6 with gram-negative bacteria,and 3 with other bacteria.Thirty-one patients were cured and one died of other diseases.Multivariate logistic regression analysis showed that age≥60 years(OR=0.366,95%CI 0.153～0.877,P= 0.024),diabetes(OR=0.153,95%CI 0.053～0.445,P=0.001),decompressive craniotomy(OR=0.213,95%CI 0.084～0.536,P=0.001),shunt exposure time≥30 min(OR=0.178,95%CI 0.071～0.446,P<0.001)were independent risk factors for infection in PTH patients after VPS.A nomogram model was constructed based on these 6 risk factors,and the total score of the model for predicting infection was 330.When the score was>180,the risk of infection in PTH patients after VPS was>90%.ROC curve analysis showed that the area value under the curve of the model was significantly higher than that of any single risk factor(P<0.05).Conclusions Elder age,diabetes mellitus,decompressectomy and long shunt exposure time are high risk factors for infection in PTH patients after VPS.The nomogram model constructed according to these high risk factors has good predictive value,and can provide reference for clinical prediction and treatment of infection in PTH patients after VPS.