MEMPHIS, TN— For the second year in a row, Neurosurgeon Paul Klimo Jr. MD, MPH, of Le Bonheur Children’s Hospital, the University of Tennessee Health Science Center, Semmes Murphey Clinic, and St. Jude Children’s Research Hospital was awarded the Pediatrics Paper of the Year by the Congress of Neurological Surgeons (CNS) during the CNS annual meeting in San Francisco, California. The paper, “The Preventable Shunt Revision Rate: A Multicenter Evaluation,” was published in Neurosurgery in March 2019.
The Preventable Shunt Revision Rate (PSRR) was introduced in 2016 as a quality metric to determine which shunt failures were avoidable. Shunt surgery is the most common procedure performed in neurosurgery, and shunt malfunction is the second most common cause of rehospitalization in children.
“PSRR goes directly to the heart of the current quality movement in health care,” said Klimo. “Quality metrics lead to the implementation of processes to avert negative consequences and maximize positive results.”
The paper evaluated two years of shunt operations data from nine participating centers in North America to determine the PSRR across institutions as well as the most common reasons for shunt failure. Of the 5,092 shunt operations performed, 861 failed within 90 days, an overall failure rate of 16.9 percent.
Of the failed shunts, 307 were determined to be potentially preventable — an overall 90-day PSRR of 35.7 percent. Preventability was defined as cerebrospinal fluid (CSF) infection, wound breakdown or infection, suboptimal position of the proximal or distal catheter or an improperly assembled or inadequately secured shunt that resulted in postoperative disconnection, migration, kinking or obstruction. The most common etiologies of preventable failure were shunt infection, malposition of the proximal catheter and an error in judgment.
This study shows that approximately one third of early shunt failures are preventable. The paper suggests that the overall shunt infection rate for any major children’s institution should be 5percent or less. Predictors of preventable failure included lack of endoscopy, recent shunt infection, shunt type and participating center.
“Direct involvement and oversight by staff is critical and can help reduce the risk of all causes for preventable shunt failures,” said Klimo. “PSRR allows practitioners and institutions to identify areas that may be improved such as investing in image guidance technology, implementing a shunt surgery checklist and reaching out to general surgeons to assist in accurate distal catheter placement.”
Future efforts with PSRR include creating a real-world registry as well as re-evaluating centers that have implemented changes in an effort to lower PSRR.
Klimo is an associate professor for the University of Tennessee Health Science Center and is also a physician for Semmes Murphey Clinic. Klimo’s winning Pediatrics Paper of the Year in 2018 was for his research on survival rates for pineoblastoma tumors.
About Le Bonheur Children’s:
Le Bonheur Children’s Hospital in Memphis, Tenn., treats children through community programs, regional clinics and a 255-bed state-of-the-art hospital. Le Bonheur serves as a primary teaching affiliate for the University Tennessee Health Science Center and trains more than 350 pediatricians and specialists each year. Nationally recognized, Le Bonheur is ranked by U.S. News & World Report as a Best Children’s Hospital.
About University of Tennessee Health Science Center:
As Tennessee’s only public, statewide, academic health system, the mission of the University of Tennessee Health Science Center is to bring the benefits of the health sciences to the achievement and maintenance of human health through education, research, clinical care, and public service, with a focus on the citizens of Tennessee and the region. The main campus in Memphis includes six colleges: Dentistry, Graduate Health Sciences, Health Professions, Medicine, Nursing and Pharmacy. UTHSC also educates and trains medicine, pharmacy, and/or health professions students, as well as medical residents and fellows, at major sites in Knoxville, Chattanooga and Nashville. For more information, visit www.uthsc.edu. Find us on Facebook: facebook.com/uthsc, on Twitter: twitter.com/uthsc and on Instagram: instagram.com/uthsc.