Ventriculoperitoneal shunt management strategies during emergency abdominal surgery: A retrospective cohort analysis.

Abstract

Background: Emergency general surgery interventions may risk infection of previously implanted ventriculoperitoneal shunts, yet evidence guiding intraoperative shunt management in adults is limited. We evaluated postoperative shunt-related infections among adults with ventriculoperitoneal shunts undergoing emergency general surgery.

Methods: We performed a single-institution 25-year (2000-2025) retrospective cohort study of adults (≥18 years) with ventriculoperitoneal shunts undergoing emergency general surgery. The primary outcome was ventriculoperitoneal shunt infection within 30 days, stratified by Centers for Disease Control and Prevention surgical wound class.

Results: Forty-five patients with ventriculoperitoneal shunts undergoing emergency general surgery were included. Median age was 63 years (interquartile range, 39-73), and 62.2% were male. The most common emergency general surgery diagnoses were classified as biliary (35.6%), small bowel (20%), and appendiceal (17.8%). Minimally invasive approaches were used in 42.2% of cases. The most common wound class was II (44.4%), followed by III (28.9%) and IV (17.8%). Among 44 patients with available shunt-management data, ventriculoperitoneal shunt was maintained at the time of emergency general surgery in 37 (84.1%). Valve types were programmable in 46.7%. Antibiotic-impregnated catheters were present in 64.4% of patients. The 30-day ventriculoperitoneal shunt-related infection rate was 4.4%. The first occurred following a laparoscopic appendectomy (wound class III, day 2); the ventriculoperitoneal shunt was removed on postoperative day 2, followed by eventual replacement after completing antibiotic therapy. The second infection was following percutaneous endoscopic gastrostomy placement (wound class II, day 4); ventriculoperitoneal shunt was removed, and temporary ventricular drainage was established. This patient suffered an unrelated mortality prior to reimplantation.

Conclusion: Our study suggests that, in selected adults with ventriculoperitoneal shunts undergoing emergency general surgery, shunt preservation is associated with a low rate of shunt-related infection, with no observed adverse consequences among patients who subsequently required shunt explantation.