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Patients with increased pressure hydrocephalus are a common referral to the Department of Neurosurgery at Dr George Mukhari Academic Hospital (DGMAH) in Pretoria, South Africa.  Aim: Our study aimed to establish our incidence and evaluate the known risk factors for ventriculo-peritoneal shunt sepsis in all patients whom had a ventriculo-peritoneal shunt inserted during the study period and whom completed 12 months of post-operative follow-up.  Methods: A retrospective cross-sectional study was performed considering all ventriculo-peritoneal shunt procedures performed between the 01 January 2013 and the 31 December 2015, consecutively drawn from the Neurosurgical operating room operative logbook.  Results: Overall 172 ventriculo-peritoneal shunts were inserted during the study period, 106 (62%) of which were inserted in children and 65 (38%) were inserted in adults. With regards the children (n=106) the most common etiology of hydrocephalus was congenital in 48 (45%) of patients while in adults (n=65) the commonest etiology was tuberculous meningitis in 15 (23%) of cases. Of the 172 patients whom had a ventriculo-peritoneal shunt inserted, 39 (23%) were deceased before completion of the one year post-operative follow-up period. The most common cause of death in this deceased group was progressive neoplastic disease in 20 (51%) of patients and tuberculous meningitis not responsive to cerebrospinal fluid diversion in 12 (31%) of patients. Of the 134 subjects whom had a ventriculo-peritoneal shunt inserted and completed the 1-year post-operative follow-up, 7 (5.2%) developed ventriculo-peritoneal shunt sepsis within the one year follow-up period.  The presence of a cerebrospinal fluid leak post the ventriculo-peritoneal shunt procedure (p=0.02) and having had more than two prior ventriculo-peritoneal shunt surgeries (p=0.027) were statistically associated with an increased chance of developing ventriculo-peritoneal shunt sepsis in our study.  Conclusion: Our study confirmed our institutional ventriculo-peritoneal shunt sepsis rate to be 5.2% and furthermore confirmed the significance of two of the known risk factors as taken from the literature. A further finding was that in our setting this procedure was often palliative. Thirty nine (23%) of subjects, despite being afforded the benefit of CSF diversion,  demised within 1 year of the procedure due to progression of their underlying disease.

Evaluating the Incidence and Risk factors for ventriculo-peritoneal shunt sepsis