We are all working hard to give the best care possible to all of our patients.  I truly appreciate the trust you and your parents give to this practice and we do our best to honor that trust. 

These are some of the
FIRST DO NO HARM: OUTCOME BASED ANALYSIS OF VENTRICULO-PERITONEAL SHUNT INFECTIONS
Introduction: Ventriculo-peritoneal shunt infections are the most common infectious complication in pediatric neurosurgery.  In 2003, the Orlando pediatric ventriculo-peritoneal shunt infection rate of 8.6% was slightly above the national average.  In an effort to reduce the infection rate, a protocol was introduced to be used in all shunt surgeries.

Methods: We prospectively gathered data on all shunt implants.  Our protocol consisted of: 1. Minimizing surgical personnel in the OR(<4 is preferred)  2. Eliminating use of surgical assistance  3. Minimizing surgical time(<15 minutes is preferred)  4. Using anti-biotic impregnated shunts(if possible)  5. Minimizing use of programmable valves  6. Performing shunts with neuro team, as a first case.  We followed all shunts for a minimum of 6 months,
outcomes.  The rates for 2005 and 2007 are similar(although the 6 month follow-up is not done for 2007).  I believe that, if MDs don’t devise appropriate outcomes-based tool, others will impose them on us.
and defined a shunt infection as a positive CSF culture within 6 months of surgery.  Variables such as patient age, number of shunt operations, length of stay, concomitant medical diagnoses, etc were analyzed to minimize confounding factors.

Results: The infection rate at Arnold Palmer Hospital dropped from 20.6% in 2003 to 1.8% in 2006(p<0.001), while other variables usually associated with increased infection risk, e.g. younger patient age, more complex medical issues/diagnoses, trended toward higher risk.  The only infection in 2006 was in a patient with >100 previous shunt operations, whose skin broke down and she developed a candidal shunt infection.

Conclusions: With stringent adherence to a strict protocol, <2% is an attainable goal in terms of ventriculo-peritoneal shunt infection rates.  Physicians must be at the forefront of assessing appropriate protocols to be used for analysis in outcomes based medicine.