Original Paper

Audits Can Improve Neurosurgical Practice - Illustrated by Endoscopic Third Ventriculostomy
Torstein R. Meling^a, Christian Tiller^a, Bernt J. Due-Tønnessen^a, Arild Egge^a, Per Kristian Eide^a, Kathrine Frey Frøslie^b, Tryggve Lundar^a, Eirik Helseth^a

Departments of
^aNeurosurgery and
^bBiostatistics, The National Hospital, Oslo, Norway

Address of Corresponding Author

Pediatric Neurosurgery 2007;43:482-487 (DOI: 10.1159/000108791)

  Key Words

• Audit
• Clinical practice
• Endoscopy
• Third ventriculostomy
• Hydrocephalus
• Quality control

  Abstract

Objective: A single-center, retrospective study was performed to evaluate the effect of audit on the patient selection for endoscopic third ventriculostomy (ETV). Materials and Methods: Between 01.01.99 and 07.31.01, 134 patients underwent ETV (group 1). During this period, there was no consensus within the neurosurgical community as to patient selection criteria for ETV. A review of our clinical practice in August 2001 demonstrated significantly lower ETV success rates for patients <6 months of age, patients with communicating hydrocephalus (HC) and for patients with prior shunt surgery. Thus, stricter patient selection criteria were established. Between 08.01.01 and 12.31.02, 54 patients were operated (group 2). The two groups were compared with respect to age, type of HC, previous shunt surgeries and ETV success rates. The primary outcome event was ETV malfunction, defined as symptoms and/or signs of increased intracranial pressure leading to repeat ETV or shunt implantation. Follow-up was done through outpatient clinics and telephone interviews. Average follow-up time was 12 months (range 0-44 months). No patient was lost to follow-up. Results: The overall 1-year ETV success rate in group 2 (65%) was significantly higher than in group 1 (53%) (p < 0.04). Group 2 had a significantly higher proportion of patients >6 months of age (p = 0.013) and with obstructive HC (p = 0.001). Conclusion: Patient selection criteria critically affect the overall ETV success rate. An audit of our results led to a significant change in clinical practice, thereby improving the ETV success rates and patient care.

Copyright © 2007 S. Karger AG, Basel

  Author Contacts

Torstein R. Meling, MD, PhD
Department of Neurosurgery
The National Hospital
NO-0027 Oslo (Norway)
Tel. +47 23 07 00 00, Fax +47 23 07 43 10, E-Mail torstein.meling@rikshospitalet.no

  Article Information

Received: October 19, 2006
Accepted after revision: February 15, 2007
Number of Print Pages : 6
Number of Figures : 2, Number of Tables : 3, Number of References : 37