Factors Predicting Ventriculostomy Revision at a Large Academic Medical Center

Background Freehand bedside ventriculostomy placement can result in catheter malfunction requiring a revision procedure and cause significant patient morbidity. We performed a single-center retrospective review to assess factors related to this complication. Methods Using an administrative database and chart review, we identified 101 first-time external ventricular drain placements performed at the bedside. We collected data regarding demographics, medical comorbidities, complications, and catheter tip location. We performed univariate and multivariate statistical analyses using MATLAB. We corrected for multiple comparisons using the false discovery rate (FDR) procedure. Results Multivariate regression analyses revealed that revision procedures were more likely to occur after drain blockage (odds ratio [OR] 17.9) and hemorrhage (OR 10.3, FDR-corrected P values P  = 0.009, FDR-corrected P P values n  = 30, 29.7%), intraparenchymal hemorrhage with intraventricular extravasation ( n  = 24, 23.7%), tumor ( n  = 20, 19.8%), and trauma ( n  = 17, 16.8%). Most common complications included drain blockage ( n  = 12, 11.8%) and hemorrhage ( n  = 8, 7.9%). In total, 16 patients underwent at least 1 revision procedure (15.8%). Conclusions Bedside external ventricular drain placement is associated with a 15% rate of revision, that typically occurred after drain blockage and postprocedure hemorrhage. Optimal placement within the ipsilateral frontal horn or foramen of Monroe was associated with a reduced rate of drain blockage.