{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T09:52:48Z","timestamp":1776851568380,"version":"3.51.2"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,16]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Patients with ventriculoperitoneal shunts have a lifelong risk of requiring revision procedures that may be time critical. Many of these patients reside distantly from neurosurgical services; however, the influence of this key sociodemographic factor on the outcomes of patients with ventriculoperitoneal shunts has not been previously studied. The Australasian Shunt Registry provides a rare opportunity to study the association of rurality with ventriculoperitoneal shunt outcomes across a large landmass with a broadly distributed population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Data were extracted from the Australasian Shunt Registry for all patients aged \u2264 25 years who underwent first-time ventriculoperitoneal shunt insertion from December 2016 to October 2024. The patient\u2019s postcode of residence was matched to the corresponding Modified Monash Model (MM) rurality index for that region. The metropolitan cohort was defined as all patients with MM 1, and the rural\/regional cohort included all patients with MM \u2265 2. The primary outcome of interest was time from ventriculoperitoneal shunt insertion to first shunt revision (shunt survival).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>At the conclusion of the study period, the Australasian Shunt Registry contained records for 5023 unique patients. After application of exclusion criteria, the resulting sample included 930 patients. The majority of these patients reside in a metropolitan MM1 area (617\/930 [66%]). The cohorts were similar for demographic and clinical variables. The estimated mean shunt survival was 5.04 (95% CI 4.64\u20135.43) years for rural patients and 5.69 (95% CI 5.40\u20135.98) years for metropolitan patients (Wilcoxon test, p = 0.01). That effect remained statistically significant in the Cox proportional hazards model that included all variables that were significant on univariate analysis: a metropolitan address exerted a protective effect on overall shunt survival (HR 0.75, 95% CI 0.59\u20130.95, p = 0.02).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Rural\/regional patients with ventriculoperitoneal shunts experienced reduced overall shunt survival when compared to metropolitan patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.9.peds25388","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T12:00:11Z","timestamp":1769083211000},"page":"297-302","source":"Crossref","is-referenced-by-count":1,"title":["Association of rurality with reduced shunt survival in child and young adult hydrocephalus: a prospective nationwide cohort from the Australasian Shunt Registry"],"prefix":"10.3171","volume":"37","author":[{"given":"Michael J.","family":"Stuart","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Queensland Children\u2019s Hospital, South Brisbane, Queensland;"},{"name":"College of Medicine and Dentistry, James Cook University, Townsville, Queensland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison","family":"Wray","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Royal Children\u2019s Hospital, Melbourne, Victoria; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Dexter","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Children\u2019s Hospital at Westmead, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert A. J.","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Queensland Children\u2019s Hospital, South Brisbane, Queensland;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Childs Nerv Syst","first-page":"101","article-title":"Long-term mortality rates in pediatric hydrocephalus-a retrospective single-center study","volume":"33","author":"Gmeiner M","year":"2017","unstructured":"Gmeiner M, Wagner H, Zacherl C,  Long-term mortality rates in pediatric hydrocephalus-a retrospective single-center study. Childs Nerv Syst. 2017;33(1):101\u2013109."},{"issue":"6","key":"b2","series-title":"J Neurosurg Pediatr","first-page":"633","article-title":"Pediatric hydrocephalus: 40-year outcomes in 128 hydrocephalic patients treated with shunts during childhood. Assessment of surgical outcome, work participation, and health-related quality of life","volume":"16","author":"Paulsen AH","year":"2015","unstructured":"Paulsen AH, Lundar T, Lindegaard KF. Pediatric hydrocephalus: 40-year outcomes in 128 hydrocephalic patients treated with shunts during childhood. Assessment of surgical outcome, work participation, and health-related quality of life. J Neurosurg Pediatr. 2015;16(6):633\u2013641."},{"issue":"4","key":"b3","series-title":"J Neurosurg Pediatr","first-page":"338","article-title":"The utility of routine intraoperative CSF during ventricular shunt insertion: a 10-year retrospective cohort study","volume":"35","author":"Stuart MJ","year":"2025","unstructured":"Stuart MJ, Harbison AM, Ruder T,  The utility of routine intraoperative CSF during ventricular shunt insertion: a 10-year retrospective cohort study. J Neurosurg Pediatr. 2025;35(4):338\u2013344."},{"issue":"6","key":"b4","series-title":"J Clin Neurosci","first-page":"614","article-title":"Preliminary study of shunt related death in paediatric patients","volume":"11","author":"Bryant MJ","year":"2004","unstructured":"Bryant MJ, McEniery J, Walker DG,  Preliminary study of shunt related death in paediatric patients. J Clin Neurosci. 2004;11(6):614\u2013615."},{"key":"b5","series-title":"Australasian Shunt Register. Neurosurgical Society of Australasia;","article-title":"Snapshot Report of Shunt Registry","year":"2024","unstructured":"Snapshot Report of Shunt Registry. Australasian Shunt Register. Neurosurgical Society of Australasia; 2024.Accessed October 8, 2025.https:\/\/www.nsa.org.au\/Public\/Public\/Shunt_Registry\/"},{"key":"b6","series-title":"Neurosurgical Society of Australasia;","article-title":"Australasian Shunt Registry Annual Report 2023","year":"2023","unstructured":"Australasian Shunt Registry Annual Report 2023. Neurosurgical Society of Australasia; 2023.Accessed October 8, 2025.https:\/\/nsa.org.au\/common\/Uploaded%20files\/Registry\/SR_AnnualReport2023%205434182628.pdf"},{"key":"b7","series-title":"Australian Government Department of Health and Aged Care","article-title":"Modified Monash Model","unstructured":"Modified Monash Model. Australian Government Department of Health and Aged Care. Accessed October 8, 2025.https:\/\/www.health.gov.au\/topics\/rural-health-workforce\/classifications\/mmm"},{"issue":"1","key":"b8","series-title":"J Neurosurg","first-page":"145","article-title":"Factors associated with 30-day ventriculoperitoneal shunt failure in pediatric and adult patients","volume":"130","author":"Anderson IA","year":"2019","unstructured":"Anderson IA, Saukila LF, Robins JMW,  Factors associated with 30-day ventriculoperitoneal shunt failure in pediatric and adult patients. J Neurosurg. 2019;130(1):145\u2013153."},{"key":"b9","series-title":"Australian Bureau of Statistics","article-title":"Census data","unstructured":"Census data. Australian Bureau of Statistics. Accessed September 12, 2024.https:\/\/www.abs.gov.au\/census\/find-census-data\/search-by-area"},{"issue":"5","key":"b10","series-title":"Childs Nerv Syst","first-page":"791","article-title":"Analysis of factors affecting ventriculoperitoneal shunt survival in pediatric patients","volume":"29","author":"Khan F","year":"2013","unstructured":"Khan F, Shamim MS, Rehman A, Bari ME. Analysis of factors affecting ventriculoperitoneal shunt survival in pediatric patients. Childs Nerv Syst. 2013;29(5):791\u2013802."},{"issue":"4","key":"b11","series-title":"Childs Nerv Syst","first-page":"943","article-title":"Revision rates of flow- versus pressure-regulated ventricular shunt valves for the treatment of hydrocephalus in neonates following germinal matrix haemorrhage\u2014a retrospective review","volume":"39","author":"Mulcahy T","year":"2023","unstructured":"Mulcahy T, Ma N. Revision rates of flow- versus pressure-regulated ventricular shunt valves for the treatment of hydrocephalus in neonates following germinal matrix haemorrhage\u2014a retrospective review. Childs Nerv Syst. 2023;39(4):943\u2013952."},{"issue":"2","key":"b12","series-title":"Cureus","first-page":"e54362","article-title":"Ventriculoperitoneal shunt failure and cerebrospinal fluid protein: a meta-analysis and systematic review","volume":"16","author":"Rei KM","year":"2024","unstructured":"Rei KM, Ghauri MS, Uddin MB, Siddiqi J. Ventriculoperitoneal shunt failure and cerebrospinal fluid protein: a meta-analysis and systematic review. Cureus. 2024;16(2):e54362."},{"issue":"1","key":"b1","series-title":"Childs Nerv Syst","first-page":"101","article-title":"Long-term mortality rates in pediatric hydrocephalus-a retrospective single-center study","volume":"33","author":"Gmeiner M","year":"2017","unstructured":"Gmeiner M, Wagner H, Zacherl C,  Long-term mortality rates in pediatric hydrocephalus-a retrospective single-center study. Childs Nerv Syst. 2017;33(1):101\u2013109."},{"issue":"6","key":"b2","series-title":"J Neurosurg Pediatr","first-page":"633","article-title":"Pediatric hydrocephalus: 40-year outcomes in 128 hydrocephalic patients treated with shunts during childhood. Assessment of surgical outcome, work participation, and health-related quality of life","volume":"16","author":"Paulsen AH","year":"2015","unstructured":"Paulsen AH, Lundar T, Lindegaard KF. 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Neurosurgical Society of Australasia; 2023.Accessed October 8, 2025.https:\/\/nsa.org.au\/common\/Uploaded%20files\/Registry\/SR_AnnualReport2023%205434182628.pdf"},{"key":"b7","series-title":"Australian Government Department of Health and Aged Care","article-title":"Modified Monash Model","unstructured":"Modified Monash Model. Australian Government Department of Health and Aged Care. Accessed October 8, 2025.https:\/\/www.health.gov.au\/topics\/rural-health-workforce\/classifications\/mmm"},{"issue":"1","key":"b8","series-title":"J Neurosurg","first-page":"145","article-title":"Factors associated with 30-day ventriculoperitoneal shunt failure in pediatric and adult patients","volume":"130","author":"Anderson IA","year":"2019","unstructured":"Anderson IA, Saukila LF, Robins JMW,  Factors associated with 30-day ventriculoperitoneal shunt failure in pediatric and adult patients. 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