1040 Safety of the Use of a Handmade External Ventricular Drain Versus a Classic Prefabricated One: A Retrospective Cohort

INTRODUCTION: Access to neurosurgical care in Peru is limited, with government delays driving patients to seek alternative solutions. METHODS: A retrospective observational cohort study was carried out during the period from January 2021 to April 2023. Patients admitted to the Neurosurgery Department of the Daniel Alcides CarriÓn National Hospital who received the placement of an artisanal or prefabricated external ventricular drain were included in the study. Medical records were used to collect demographic data, clinical and surgical variables. Our primary outcome was nervous system infection post-EVD placement. A multivariate analysis using logistic regression was performed, adjusting for variables using p<0.25 as cohort point and clinical criterion. To avoid overfitting the model, we limited ourselves to only two predictor variables until adequate model performance was achieved. RESULTS: A total of 23 patients were included, of which 12 were treated with a handmade DVE and 11 with a prefabricated DVE. The average age was 47.3 years and 52% were male. Six patients in the artisanal group presented infection of the nervous system, while 6 in the prefabricated group also presented infection, but without a statistically significant difference (p=0.51). Similarly, 5 patients with artisanal DVE needed DVE replacement while 3 patients with prefabricated DVE needed DVE, without a statistically significant difference (p=0.478). In the multivariate analysis, we found no association of artisanal DVE with CNS infection (OR = 4.64 [95% CI 0.43 - 49.85]), or with DVE replacement (OR=1.90 [95% CI 0.33-11]. CONCLUSIONS: Our homemade DVE matches prefabricated ones in safety and cost-effectiveness, costing $10 versus $200, with similar rates of complications like meningitis and ventriculitis.