{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T15:27:27Z","timestamp":1791646047788,"version":"4.3.4"},"reference-count":13,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:00:00Z","timestamp":1776384000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: Lumboperitoneal (LP) shunt surgery is an established treatment for idiopathic normal pressure hydrocephalus (iNPH). In Japan, patients undergoing LP shunt surgery are often hospitalized for several days to more than one week after surgery, even in uncomplicated cases, reflecting concerns regarding early complications, cerebrospinal fluid overdrainage, and discharge readiness in older adults. This study evaluated the feasibility and short-term safety of a perioperative optimization pathway for planned short-stay hospitalization after LP shunt surgery. Methods: This single-center retrospective before-and-after cohort study included 15 consecutive patients who underwent elective LP shunt surgery. Six patients were managed using a conventional hospitalization pathway, whereas nine patients were treated under a short-stay pathway targeting discharge after one postoperative night. Key perioperative modifications included a uniform higher initial programmable valve pressure (level 7), structured discharge education, scheduled postoperative analgesia, waterproof wound sealing permitting early showering, and early outpatient follow-up with head computed tomography for staged valve pressure adjustment. The primary outcome was 30-day safety, defined as readmission, reoperation, or major postoperative complications. Results: Baseline characteristics were generally comparable between groups, although the short-stay group was slightly older and had more frequent antithrombotic therapy. Mean hospital length of stay was shorter in the short-stay group than in the conventional group (3.7 \u00b1 2.0 vs. 9.7 \u00b1 0.8 days; median, 3 vs. 9.5 days). Orthostatic headache requiring valve adjustment occurred in three conventional cases but in none of the short-stay patients. No patients in the short-stay group required readmission or reoperation within 30 days. Conclusions: In this pilot before-and-after study, a short-stay LP shunt pathway incorporating perioperative optimization and individualized discharge decision-making was feasible and was not associated with an apparent increase in early adverse events. These findings should be interpreted as exploratory and may support further evaluation of short-stay management strategies for selected patients undergoing LP shunt surgery in Japan.<\/jats:p>","DOI":"10.3390\/jpm16040223","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T10:11:04Z","timestamp":1776420664000},"page":"223","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Feasibility of a Short-Stay Lumboperitoneal Shunt Pathway Based on Perioperative Optimization and Individualized Discharge Decision-Making: A Pilot Before\u2013After Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9259-7443","authenticated-orcid":false,"given":"Tatsuya","family":"Tanaka","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-8520, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5352-2214","authenticated-orcid":false,"given":"Eiichi","family":"Suehiro","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-8520, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anh Tran","family":"Hue","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-8520, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryosuke","family":"Doi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-8520, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunsuke","family":"Hatakenaka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-8520, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junpei","family":"Kato","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-8520, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomihiro","family":"Wakamiya","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-8520, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4427-3874","authenticated-orcid":false,"given":"Kimihiro","family":"Nakahara","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-8520, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Agari","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-8520, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1997-1125","authenticated-orcid":false,"given":"Masahiro","family":"Indo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-8520, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Sugawara","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-8520, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Itokawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-8520, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuaki","family":"Shimoji","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-8520, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Onoda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-8520, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Matsuno","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-8520, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/S1474-4422(15)00046-0","article-title":"Lumboperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (SINPHONI-2): An open-label randomised trial","volume":"14","author":"Kazui","year":"2015","journal-title":"Lancet Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.3171\/2015.10.JNS151894","article-title":"One-year outcome in patients with idiopathic normal-pressure hydrocephalus: Comparison of lumboperitoneal shunt to ventriculoperitoneal shunt","volume":"125","author":"Miyajima","year":"2016","journal-title":"J. Neurosurg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"162","DOI":"10.25259\/SNI_209_2025","article-title":"Cerebrospinal fluid diversion procedure utilization and physician reimbursement in adult hydrocephalus patients","volume":"16","author":"Tang","year":"2025","journal-title":"Surg. Neurol. Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"63","DOI":"10.2176\/nmc.st.2020-0292","article-title":"Guidelines for management of idiopathic normal pressure hydrocephalus (third edition): Endorsed by the Japanese Society of Normal Pressure Hydrocephalus","volume":"61","author":"Nakajima","year":"2021","journal-title":"Neurol. Med. Chir."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"420","DOI":"10.2176\/jns-nmc.2022-0367","article-title":"Lumboperitoneal shunt surgery under spinal anesthesia on idiopathic normal pressure hydrocephalus patients","volume":"63","author":"Goto","year":"2023","journal-title":"Neurol. Med. Chir."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"339","DOI":"10.3171\/2024.4.JNS24601","article-title":"Impact of standardized care guidelines featuring next-day discharge on outcome, healthcare consumption, and patient healthcare experience in patients with idiopathic normal pressure hydrocephalus receiving ventriculoperitoneal shunts","volume":"142","author":"Backlund","year":"2024","journal-title":"J. Neurosurg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1093\/intqhc\/mzt056","article-title":"What is known about adverse events in older medical hospital inpatients? A systematic review of the literature","volume":"25","author":"Long","year":"2013","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1782","DOI":"10.1001\/jama.2011.1556","article-title":"Hospitalization-associated disability: \u201cShe was probably able to ambulate, but I\u2019m not sure\u201d","volume":"306","author":"Covinsky","year":"2011","journal-title":"JAMA"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"110575","DOI":"10.1016\/j.jclinane.2021.110575","article-title":"Enhanced recovery after elective craniotomy: A randomized controlled trial","volume":"76","author":"Wang","year":"2022","journal-title":"J. Clin. Anesth."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"181","DOI":"10.3171\/jns.2000.92.1.0181","article-title":"New concept for the pressure setting of a programmable pressure valve and measurement of in vivo shunt flow performed using a microflowmeter","volume":"92","author":"Miyake","year":"2000","journal-title":"J. Neurosurg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"124897","DOI":"10.1016\/j.wneu.2026.124897","article-title":"Fluoroscopic Myelography-Guided Lumboperitoneal Shunt Placement to Reduce the Risk of Spinal Subdural-Extra-Arachnoid Catheter Misplacement: A Technical Note","volume":"209","author":"Tanaka","year":"2026","journal-title":"World Neurosurg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"109113","DOI":"10.1016\/j.clineuro.2025.109113","article-title":"Prevention of valve reversal in lumboperitoneal shunt surgery: Effectiveness of above-the-superficial-fascia placement using an inline shunt passer","volume":"257","author":"Tanaka","year":"2025","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.3171\/2025.3.JNS242345","article-title":"Lumboperitoneal shunt placement under local anesthesia: A technical note from an experience with more than 200 cases","volume":"143","author":"Inoue","year":"2025","journal-title":"J. Neurosurg."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/4\/223\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T10:32:32Z","timestamp":1776421952000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/4\/223"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,17]]},"references-count":13,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jpm16040223"],"URL":"https:\/\/doi.org\/10.3390\/jpm16040223","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,17]]}}}