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BACKGROUND Delayed intracranial hemorrhage (DICH), a potential complication of ventriculoperitoneal (VP) shunts, has been associated with high mortality, but its risk factors are still unclear. AIM To investigate the risk factors of DICH after VP shunts. METHODS We compared the demographic and clinical characteristics of DICH and non-DICH adult patients with VP shunts between January 2016 and December 2020. RESULTS The 159 adult VP shunt patients were divided into 2 groups according to the development of DICH: the DICH group (n = 26) and the non-DICH group (n = 133). No statistically significant difference was found in age, sex, laboratory examination characteristics or preoperative modified Rankin Scale (mRS) score between the DICH and non-DICH groups (P > 0.05); however, a history of an external ventricular drain (EVD) [P = 0.045; odds ratio (OR): 2.814; 95%CI: 1.024-7.730] and postoperative brain edema around the catheter (P < 0.01; OR: 8.397; 95%CI: 3.043-23.171) were associated with a high risk of DICH. A comparison of preoperative mRS scores between the DICH group and the non-DICH group showed no significant difference (P = 0.553), while a significant difference was found in the postoperative mRS scores at the 3-mo follow-up visit (P = 0.024). CONCLUSION A history of EVD and postoperative brain edema around the catheter are independent risk factors for DICH in VP shunt patients. DICH patients with a high mRS score are vulnerable to poor clinical outcomes.