Thoracoscopic ligation versus coil occlusion for patent ductus arteriosus: a matched cohort study of outcomes and cost.
BACKGROUND
Coil occlusion (CO) and video-assisted thoracoscopic surgery (VATS) have both emerged as minimal access therapies for patent ductus arteriosus (PDA). These techniques have not previously been statistically compared.


METHODS
Twenty-four consecutive children undergoing VATS for PDA were each retrospectively matched by PDA diameter and child weight to two children undergoing CO (total 48) during the same time period. The two modalities were compared with respect to outcome and cost. Statistical analysis was performed using a Student's t-test and Mantel-Haenszel relative risk. Cost analysis from an institutional perspective was used to compare resource consumption.


RESULTS
Mean PDA diameter was 3.6 +/- 1.2 mm in both groups. Mean age and weight for VATS and CO children were 2.7 and 2.9 yrs and 13.2 and 13.1 kg, respectively. Mean surgical times were 94 +/- 34 min for VATS and 50 +/- 23 min for CO (p < 0.0001). Mean length of stay was 1.6 +/- 0.2 days for VATS and 0.6 +/- 0.2 days for CO (Mantel-Haenszel RR (95% CI) = 0.15 [0.07, 0.29], p < 0.0001). Mean fluoroscopy time with CO was 13 +/- 7 min. No VATS or CO children required conversion to open surgical ligation. Two children in each arm (8% VATS, 4% CO) required indefinite antibiotic endarteritis prophylaxis for a persistent shunt. The cost per child was C$ 4282.80 (Canadian dollars) for VATS and C$ 3958.08 for CO.


CONCLUSIONS
VATS is as efficacious for PDA closure as CO but requires longer surgical times and lengths of stay. Costs for each procedure are similar.
Dutta
Sanjeev
S
Division of Pediatric Surgery, Lucile Packard Children's Hospital at Stanford University, Stanford 94305-5733, USA. sdutta1@stanford.edu
Mihailovic
Alexandra
A
Benson
Lee
L
Kantor
Paul F
PF
Fitzgerald
Peter G
PG
Walton
J Mark
JM
Langer
Jacob C
JC
Cameron
Brian H
BH
D021721:Balloon Occlusion / Q000191:economics*; D002675:Child, Preschool; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000191:economics / Q000628:therapy*; D004452:Echocardiography; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging / Q000191:economics / Q000628:therapy*; D007902:Length of Stay / Q000191:economics; D008026:Ligation / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000191:economics*; D013908:Thoracotomy; D016896:Treatment Outcome