Factors Influencing Receipt of Shunt Surgery in Hydrocephalus PatientsName : Dr. Gabriel D. Pinilla
Affliation : Department Of Neurosurgery
University : Johns Hopkins Hospital
Country : Baltimore, USA
Background: Hydrocephalus often adversely affects quality of life in elderly populations. A previous study of the Medicare database has proposed some sociodemographic and clinical factors that influence the receipt of shunt surgery in these patients. The aim of this review was to assess if the prevalence of hydrocephalus has changed over time and to identify the factors influencing which patients received a shunt procedure.
Materials and Methods: Retrospective study based on the Standard Analytical Files collected between 2006 and 2010 by the United States Centers for Medicare and Medicaid Services. Initially, a random sample of 5% Medicare beneficiaries (2,378,637), enrolled in both Part A (inpatient) and Part B (outpatient), was included. Multivariable logistic regression was used to determine if socio-demographic and clinical characteristics were associated with receiving a shunt procedure.
Results: 2321 patients exhibited a diagnosis of hydrocephalus for a disease prevalence of 0.2% (a 66% increase from 0.12% in 1999). Only 24.99% of these patients underwent shunt surgery. Co-existing conditions like peripheral neuropathy (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.01-1.64) and subdural hematoma (OR 4.42, 95%CI 3.38-5.79) were associated with undergoing a shunt procedure. On the other hand, African-American race (OR 0.49, 95%CI 0.29-0.82), affiliation to Medicaid (OR 0.58, 95%CI 0.43-0.78) and coronary atherosclerosis (OR 0.70, 95%CI 0.55-0.88) increased the likelihood of receiving conservative treatment.
Conclusion: Our study suggests that the prevalence of hydrocephalus increased over time in Medicare beneficiaries. In contrast with previous results, Medicaid affiliation and coronary atherosclerosis seemed to be negatively associated with shunt surgery.
Biography: Gabriel Pinilla, M.D. is currently pursuing a Post-Doctoral Fellowship in Cerebrospinal Fluid Disorders at the Johns Hopkins Department of Neurosurgery. He graduated Cum Laude from the Industrial University of Santander School of Medicine, where he obtained an additional A.Sc. degree in Pharmacy Technology. He is a Pg.Cert. student in the Epidemiology program and his main research interests are translational models of neurological diseases and the statistical assessment of data below the limit of detection in the context of biomarkers concentration studies.