Liver Cirrhosis as a Predictor of Infection Risk in Patients Undergoing Ventriculoperitoneal Shunt Surgery: A Retrospective Cohort Analysis from the Taiwan National Health Insurance Research Database (NHIRD)

BACKGROUND Ventriculoperitoneal (VP) shunt surgery is a widely used procedure for managing hydrocephalus; however, postoperative infections remain a serious complication, increasing morbidity and mortality. Known risk factors include prior surgeries, steroid use, and concurrent procedures. However, the role of liver cirrhosis, a condition that compromises immune function and predisposes patients to infections, has not been fully investigated in the context of neurosurgery. Current literature lacks large-scale studies evaluating whether liver cirrhosis increases infection risk after VP shunt surgery. This study aims to address this gap using a nationally representative database, to compare the risk of postoperative infections in patients with and without liver cirrhosis following VP shunt surgery, utilizing data from the Taiwan National Health Insurance Research Database (NHIRD). MATERIAL AND METHODS A retrospective cohort study analyzed 1766 patients with and 37 995 patients without liver cirrhosis who underwent their first VP shunt surgery between January 2010 and December 2019. Infection risk was assessed at 6 months and 1 year after surgery. Additional factors, such as cerebral hemorrhage, aneurysm, brain tumors, decompressive craniectomy, and cranioplasty, were considered. Fine and Gray regression accounted for death as a competing risk. RESULTS After we adjusted for potential confounders, patients with cirrhosis showed a 1.41-fold increased risk of infection at 6 months (95% CI: 1.10-1.81, P=0.007) and 1.39-fold at 1 year (95% CI: 1.12-1.73, P=0.003) compared with patients without cirrhosis. CONCLUSIONS Liver cirrhosis significantly elevates infection risk following VP shunt surgery, highlighting the need for tailored perioperative strategies to improve outcomes for these patients.