Ventriculoperitoneal Shunt Infection in Severely Disabled Adults: Association of a Modified Tracheostomy Focused Surgical Protocol with Reduced Infection Rates.

BACKGROUND: Ventriculoperitoneal shunt (VPS) infection is a serious complication following shunt placement for hydrocephalus, particularly in patients with severe neurological impairment who require prolonged rehabilitation and invasive supportive devices such as tracheostomy and nasogastric feeding. OBJECTIVE: This study aimed to determine the incidence of VPS infection in a severely disabled adult hydrocephalus cohort and to evaluate the association between a modified surgical technique and VPS infection, alongside other potential risk factors. The findings were intended to guide the refinement and ongoing optimization of our department's standardized surgical protocols to further reduce infection risk. METHODS: We conducted a single centre retrospective before-after cohort study of 284 adults undergoing first time VPS between 2022 and 2024, comparing patients treated with the conventional technique (n = 168) and those treated after implementation of a modified, tracheostomy focused surgical protocol (n = 116). All patients were followed for 12 months, and predefined clinical, laboratory, and procedural variables were extracted from medical records. RESULTS: A total of 284 patients with hydrocephalus who were followed up for at least one year were included in the study. VPS infection occurred in 35 of 284 patients (12.3%), with 29 of 35 infections (82.8%) arising within 3 weeks of surgery. Infection rates were 17.9% (30/168) in the conventional group and 4.3% (5/116) in the modified protocol group (absolute risk reduction 13.6%), corresponding to approximately one infection prevented for every 7-8 patients treated with the modified technique (χ² = 11.654, p < 0.001). No other predefined patient related or shunt related factors showed a significant association with infection.