Factors Predicting Ventriculostomy Revision at a Large Academic Medical Center

Ashwin G. Ramayya, Gregory Glauser, Brendan Mcshane, Marc Branche, Saurabh Sinha, Svetlana Kvint, Vivek Buch, Kalil G. Abdullah, David Kung, H. Isaac Chen, Neil R. Malhotra, Ali Ozturk

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Background: Freehand bedside ventriculostomy placement can result in catheter malfunction requiring a revision procedure and cause significant patient morbidity. We performed a single-center retrospective review to assess factors related to this complication. Methods: Using an administrative database and chart review, we identified 101 first-time external ventricular drain placements performed at the bedside. We collected data regarding demographics, medical comorbidities, complications, and catheter tip location. We performed univariate and multivariate statistical analyses using MATLAB. We corrected for multiple comparisons using the false discovery rate (FDR) procedure. Results: Multivariate regression analyses revealed that revision procedures were more likely to occur after drain blockage (odds ratio [OR] 17.9) and hemorrhage (OR 10.3, FDR-corrected P values < 0.01, 0.05, respectively). Drain blockage was less frequent after placement in an “optimal location” (ipsilateral ventricle or near foramen of Monroe; OR 0.09, P = 0.009, FDR-corrected P < 0.03) but was more likely to occur after placement in third ventricle (post-hoc P values < 0.015). Primary diagnoses included subarachnoid hemorrhage (n = 30, 29.7%), intraparenchymal hemorrhage with intraventricular extravasation (n = 24, 23.7%), tumor (n = 20, 19.8%), and trauma (n = 17, 16.8%). Most common complications included drain blockage (n = 12, 11.8%) and hemorrhage (n = 8, 7.9%). In total, 16 patients underwent at least 1 revision procedure (15.8%). Conclusions: Bedside external ventricular drain placement is associated with a 15% rate of revision, that typically occurred after drain blockage and postprocedure hemorrhage. Optimal placement within the ipsilateral frontal horn or foramen of Monroe was associated with a reduced rate of drain blockage.

Original languageEnglish (US)
Pages (from-to)e509-e514
JournalWorld neurosurgery
Volume123
DOIs
StatePublished - Mar 2019
Externally publishedYes

Keywords

  • Blocked drain
  • External ventricular drain (EVD) placement
  • Hemorrhage
  • Revision
  • Third ventricle
  • Ventriculostomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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  • Cite this

    Ramayya, A. G., Glauser, G., Mcshane, B., Branche, M., Sinha, S., Kvint, S., Buch, V., Abdullah, K. G., Kung, D., Chen, H. I., Malhotra, N. R., & Ozturk, A. (2019). Factors Predicting Ventriculostomy Revision at a Large Academic Medical Center. World neurosurgery, 123, e509-e514. https://doi.org/10.1016/j.wneu.2018.11.196