Characteristics of Patients with VP Shunt Malfunction in Dr. Mohammad Hoesin General Hospital between May 2018 and July 2019

Introduction: Hydrocephalus may occur when the production of cerebrospinal fluid (CSF) is excessive or, the most common cause when, the absorption of CSF is decreased. The VP Shunt is most commonly performed worldwide as the primary treatment for hydrocephalus. The complications of VP Shunt are shunt infection, mechanical malfunction and over or under-drainage. This study aims to see the characteristics of patients affected by post VP shunt infection who are treated at dr. Mohammad Hoesin Palembang Methods: This research was a cross-sectional descriptive study. Using secondary data from the medical records of Mohammad Hoesin Hospital, Palembang. Performed in the from May 2018 to July 2019. Samples were all patients diagnosed with malfunction and infection with VP Shunt. Results: There were 23 subjects participated who met study critera. VP shunt infections were mostly male (82.6%). The largest age distribution is less than 1 year old (39.1%). The most incidence occured at the age of 1-6 months (60.9%). The most common type of surgery was emergency surgery (60.8%). The most common malfunctions were caused by shunt malfunctions (69.6%). Conclusion : Male patients, patients age <1 year old with onset of 1-6 months, and shunt malfunctons were the most common characteristic of patients diagnosed with malfunction and infection with VP Shunt.


Introduction
Hydrocephalus may occur when the production of cerebrospinal fluid (CSF) is excessive or, the A malfunction of VP shunt insertion is called shunt failure, which is the inability to achieve the goal of the operation. In CSF shunting, failure refers to the inability to achieve proper hydrocephalus control which can lead to revision, replacement, or removal of the shunt. VP shunt insertion malfunction may stem from problems related to the valve, patient, or surgery. In many cases, the terms fail ure and complication are interchangeably used in the literature. [3][4][5] Mechanical malfunction is the most frequent cause of CSF shunt failure. The incidence was 50% in pediatric cases. Shunt damage most commonly caused by proximal catheter obstruction, valve obstruction, distal catheter occlusion, shunt section rupture, tubing fracture, or proximal or distal catheter migration. Debris from the brain, choroid plexus, blood, or tissue reactions often clog the proximal catheter. Ventricular clefts and incorrect placement of a catheter in the ventricle can also interfere with flow through the catheter. The valve on the VP Shunt is a very rare part and usually occurs in some cases, and is almost always produced by a blood clot. Valve damage in the VP Shunt itself may occur for no apparent reason or may follow cranial traumatism. Distal catheter obstruction generally occurs in 206 systems with a distal gap valve and very rarely in open-ended catheters. Under unique circumstances, the distal tube may become blocked with feces, indicating bowel perforation. In the abdomen, the distal catheter may become blocked with the growth of mesothelial cells and fibroblasts. Tube kinking is also very rare and commonly due to faulty placement. [5][6][7][8] Infection is one of CSF shunt surgery complications, and its rates vary widely from studies, partly related to differences in study design, operational definition of shunt infection, and time needed to diagnose infection. Patient factors considered in relation to CSF shunt infection included chronological age, gestational age, post-conception age, gender, birth weight, weight at surgery, indications for shunt placement including myelomeningocele and IVH, comorbidities, and length of stay in the hospital before shunt placement. [3][4][5] Infection remains a serious complication of shunt surgery with mortality rates ranging from 1.5-22%. Survivors were at risk for intellectual, cognitive, and neurological disabilities.
Infection had been reported to occur in 5-15% of shunt procedures. However, several studies describe lower infection rates as ranging from 0.3-5%. Most of the studies which use prophylactic antibiotics have been inconclusive, and there is yet no definite evidence that prophylactic antibiotics reduce the rate of shunt infection. [3][4][5] Mechanical shunt complications can occur anywhere from the recovery room immediately after surgery to many years. The most common period for shunt failure is the first 6 months after its insertion.

Method
The design is cross-sectional descriptive study, using secondary data from the medical records of Mohammad Hoesin Hospital, Palembang. The study was conducted in the outpatient and inpatient installation of dr. Mohammad Hoesin Palembang between period of May 2018 -July 2019. The study 207 samples were all patients diagnosed with malfunction and infection with VP Shunt who were undergoing treatment at dr. Mohammad Hoesin Palembang between the time frame. Patients with incomplete medical record data were excluded. Variables researched were age, gender, onset of events, type of operation, and complications. The data that has been collected will be processed in statistical form using the spss program

Results
We found 23 subjects from 248 VP Shunt operations who met the study criteria. The age distribution of research subjects can be seen in

Discussion
Our study revelaed that the largest age distribution was less than 1 year, amounting to 9 people (39.1%), followed by age group of 1-5 years and 26-45 years with a total of 5 people respectively (21.7%). The results are in accordance with research conducted by Agung Muda Patih 29 in 2014 at RSCM Jakarta which implied that the age group under 1 year was the most dominant age group having VP shunt, with a percentage of 36% (9 of 25 cases). Age is a risk factor for VP-shunt infection. In some literature it is said to be premature and at the age of the child is more at risk for infection. In a study conducted at Kenyan Hospital, it was found that 49.6% of shunt infections occurred in patients with a duration of less than 6 months, there was a positive correlation between VP-shunt complications, age

Conclusion
VP shunt infections were mostly male (82.6%). The largest age distribution is less than 1 year old (39.1%). The most incidence occured at the age of 1-6 months (60.9%). The most common type of surgery was emergency surgery (60.8%). The most common malfunctions were caused by shunt malfunctions (69.6%).