Background

Shunt insertion for hydrocephalus is a common paediatric neurosurgery procedure. Shunt complications are frequent with an estimated 20–40% failure rate within the first year, and 4.5% per year subsequently. We have an open-door ‘possible shunt malfunction’ pathway for children treated with a shunt or endoscopic third ventriculostomy, providing direct ward access to ensure rapid assessment and timely management of children.

Objective

To audit the ‘possible shunt malfunction’ pathway in terms of clinical outcomes (percentage-confirmed shunt dysfunction and number of re-attendances) and costs.

Methods

Clinical data for patients attending the triage service were prospectively recorded over 7 months—including the number of attendances, previous shunt revisions, shunt type, investigations performed (CT, x-rays), and outcome. Costings (e.g. costs of physician, inpatient stay, investigations) were obtained from the hospital’s procurement department.

Results

In the study period, there were 81 attendances by 62 patients and only 16% of attendances resulted in surgical management (either shunt revision or ETV). Approximately 17% of patients re-attended at least once. The average cost per attendance in our pathway was £765.57 ($969.63; €858.73). The total expenditure for the pathway over 7 months was £62,011.03 ($78,540.07; €69,556.81), with inpatient stay making up the biggest percentage of cost (49.2%).

Conclusion

Only 16% (13 attendances) of those attending through our pathway required neurosurgical intervention. Investigations for possible blocked shunt come at significant health, social, and financial cost. High rates of shunt failure, re-attendance, investigations, and inpatient stays incur a sizable financial burden to the healthcare system.

中文翻译：

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小儿脑积水的“可能的分流失灵”途径-临床结果和费用影响的研究。

背景

脑积水的分流术是一种常见的儿科神经外科手术。分流并发症很常见，第一年内失败率估计为20-40％，随后每年4.5％。我们为接受分流或内窥镜第三脑室造口术治疗的儿童提供了一个开放式“可能的分流失灵”途径，可直接进入病房，以确保对儿童进行快速评估和及时管理。

目的

根据临床结果（已确认百分比的分流功能障碍和复诊次数）和成本来审核“可能的分流失灵”途径。

方法

前瞻性地记录了参加分诊服务的患者的临床数据，历时7个月，包括就诊人数，以前的分流术修订，分流术类型，进行的检查（CT，X射线）和结果。从医院的采购部门获得费用（例如，医师，住院，调查的费用）。

结果

在研究期间，有62位患者参加了81次就诊，只有16％的就诊者进行了手术治疗（分流翻修或ETV）。大约17％的患者至少参加一次。在我们的课程中，每次出席的平均费用为765.57英镑（969.63美元； 858.73欧元）。该途径在7个月内的总支出为62,011.03英镑（78,540.07美元； 69,556.81欧元），其中住院费用占最大比例（49.2％）。

结论

通过我们的途径就诊的人中只有16％（13出勤）需要神经外科干预。对可能的分流器进行调查需要付出巨大的健康，社会和经济成本。分流器故障，复诊，调查和住院的高发生率给医疗保健系统带来了可观的经济负担。