Background: Ventriculoperitoneal shunt procedures remain the mainstay of hydrocephalus treatment despite significant complication rates. This study analyzed the patterns and risk factors for shunt complications in a tertiary care setting. Methods: A prospective observational study of 80 patients undergoing VP shunt surgery was conducted. Patient demographics, etiology, and complications were analyzed using standardized protocols. Results: The study included 50 males (62.5%) and 30 females (37.5%), with 57.5% under one year of age. Congenital hydrocephalus (37.5%) and tubercular meningitis (18.75%) were the predominant etiologies. Overall complication rate was 20%, with obstruction (11.25%), infection (6.25%), and displacement (2.5%) being the main complications. Ventriculitis cases showed the highest complication rate (37.5%, p<0.05). Conclusion: While VP shunt complications remain significant, certain etiologies carry higher risks. Understanding these patterns can improve patient selection and management protocols.