By: Aparna Srinivasan and Dr. Jenna Koschnitzky, Director of Research Programs
Most people with hydrocephalus have to live with the condition for their whole lives. Shunt surgery is just a method of treatment for hydrocephalus, but it is not a cure. Many people with hydrocephalus require multiple hospital visits to revise the shunts due to various complications, but how do people know if they are getting the best care? A health care quality metric is a tool that helps patients make informed decisions regarding their health care.
What is a Quality Metric?
A health care quality metric is a tool that helps to measure the outcomes of various treatment options. Recently, hospitals have begun monitoring surgical procedures using quality metrics. Because shunt surgery in children is common and has a high complication rate, the following quality metrics have been defined for the Pediatric Neurosurgery patient: The Surgical Activity Rate (SAR), Revision Quotient (RQ), 30-Day Shunt Malfunction Rate, 90-Day Global Shunt Revision Rate, and the Preventable Shunt Revision Rate (PSRR). The table provides definitions for these quality metrics.
About this Study
Dr. Thomas Beez and Dr. Hans-Jakob Steiger from the Heinrich-Heine-University in Düsseldorf, Germany calculated all the above mentioned quality metrics for the 60 shunt surgeries done at their institution in 2015. In addition they introduced a new quality metric the Negative Shunt Revision Rate (NSRR).
What is the NSRR?
NSRR stands for Negative Shunt Revision Rate.
How is it calculated?
NSRR is the proportion of shunt revisions per year that reveal a properly working shunt in relation to the overall number of shunt revisions.
Why is NSRR important?
The two most common symptoms of shunt malfunction are vomiting and headaches. Both of these symptoms are non-specific and could be caused by many reasons other than shunt obstruction. If the NSRR is high it indicates that a lot of unnecessary shunt revisions were performed. This quality metric can be used by both neurosurgeons to improve their quality of care and by patients to help them make more informed decisions regarding their healthcare.
In the study, the NSRR was 7.1% (3 of 42 shunt revisions). This means that the neurosurgeons did not detect a shunt malfunction during surgery in three cases, even though the patient had symptoms consistent with shunt failure. According to the authors, the major limitation of the study was that it was a small, retrospective sample from one hospital. A larger study that collects data from many hospitals is needed to determine what the NSRR is, on average, for people with hydrocephalus.
Author Aparna Srinivasan is a junior in high school. She enjoys playing the flute in her community orchestra and the school marching band. In the future, she hopes to pursue a career in medicine.