Abstract / Summary
Abstract Introduction: Hydrocephalus is the most common neurosurgical condition of childhood, and ventriculoperitoneal (VP) shunt insertion remains its most widely used treatment. In Africa, the burden of disease is high, but published outcome data are scarce, particularly in Portuguese-speaking countries. Objectives To describe the paediatric population undergoing VP shunt insertion at the largest tertiary paediatric referral hospital in Angola and to report early and late complications, shunt revisions, and mortality. Methods Retrospective review of clinical records of children with hydrocephalus operated at a tertiary hospital in Luanda between 2021 and 2025. Records were curated (deduplication, normalisation of categorical fields, and grouping). Clinical variables and outcomes were described; associations were tested with the Mann-Whitney U test, the chi-square test, and Fisher's exact test, and with logistic regression when the events-per-variable ratio allowed. Results Of 455 records, 443 unique patients were analysed, 228 male (51.5%). Hydrocephalus was congenital in 99.8% and communicating in 95.5%. Median age at diagnosis was 14 days (interquartile range [IQR] 2–122) and at surgery 32 days (IQR 12–122). Myelomeningocele was recorded in 88 patients (19.9%), clubfoot in 33 (7.4%), and meningitis in 31 (7.0%). Early complications (< 30 days) were recorded in 110 patients (24.8%), mainly meningitis (n = 24; 5.4%) and catheter infection (n = 22; 5.0%). Hospital mortality was 8.8% (n = 39) and overall mortality (hospital or 30-day) 9.0% (n = 40); only 3 patients (0.7%) required shunt revision. Complications were associated with younger age at diagnosis (median 5 vs 22 days; p = 0.010) and at surgery (24 vs 58 days; p = 0.021). In univariable analysis, myelomeningocele was associated with complications (odds ratio [OR] 1.78; 95% CI 1.08–2.94; p = 0.029); the association attenuated after adjustment (OR 1.60; 95% CI 0.94–2.74; p = 0.085). Conclusions In this series, hospital mortality was 8.8% and about one quarter of children had early complications, predominantly meningitis and catheter infection. Short follow-up limits the estimation of revisions and long-term survival.