Effect of surgical subspecialty training on patent ductus arteriosus ligation outcomes.
OBJECTIVE
Surgical outcomes data for patent ductus arteriosus (PDA) ligation come primarily from single institution case series. The purpose of this study was to evaluate national PDA ligation trends, and to compare outcomes between pediatric general (GEN) and pediatric cardiothoracic (CT) surgeons.


METHODS
The Pediatric Health Information System database was queried to identify neonates who underwent PDA ligation from 2006 through 2009. Outcomes evaluated included surgical morbidity, in-hospital mortality, length of stay, and total charges. Outcomes were compared between pediatric general and pediatric cardiothoracic surgeons.


RESULTS
The records of 1,482 neonates who underwent PDA ligation were identified and analyzed. Overall mean gestational age was 26 ± 3 weeks and birth weight was 888 ± 428 g. The majority of patients among both surgeons had birth weights of ≤1,000 g (77.2%) and were born at ≤27-week gestation (81.5%). Most of the PDA ligations were performed by pediatric CT surgeons (n = 1,196, 80.7%). The mortality rate did not differ by surgeon subspecialty training (GEN = 5.2%, CT 7.9%, p = 0.16). Neonates in the cardiothoracic surgeon cohort showed lower length of stay (p < 0.001-0.05) and total hospital charges (p < 0.05) among patients with birth weight ≤1,200 g. Proxy measures of surgical morbidity-gastrostomy, fundoplication, and tracheostomy-showed no significant differences between the two surgical subspecialists overall or across birth weight subgroups (p > 0.05).


CONCLUSIONS
These data provide a contemporary snapshot of PDA ligation outcomes at American children's hospitals. Pediatric general surgeons achieve comparable outcomes performing PDA ligation compared to pediatric cardiothoracic surgeons.
Division of Cardiology, Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA.
Dor
D
Markush
Kelleigh E
KE
Briden
Michael
M
Chung
Katherine W
KW
Herbst
Trudy J
TJ
Lerer
Stephen
S
Neff
Amy C
AC
Wu
Brendan T
BT
Campbell
D004374:Ductus Arteriosus, Patent / Q000401:mortality / Q000601:surgery*; D005260:Female; D018662:Fundoplication / Q000706:statistics & numerical data; D005774:Gastrostomy / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007902:Length of Stay / Q000706:statistics & numerical data; D008026:Ligation; D008297:Male; D010372:Pediatrics / Q000706:statistics & numerical data*; D013903:Thoracic Surgery / Q000706:statistics & numerical data*; D014139:Tracheostomy / Q000706:statistics & numerical data; D014481:United States; D014656:Vascular Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data*