Skip to main content

Advertisement

SpringerLink
Log in

Effect of surgical subspecialty training on patent ductus arteriosus ligation outcomes

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

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).

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kitterman JA, Edmunds LH, Gregory GA et al (1972) Patent ducts arteriosus in premature infants. Incidence, relation to pulmonary disease and management. N Engl J Med 287:473–477

    Article  CAS  PubMed  Google Scholar 

  2. Investigators of the Vermont-Oxford Trials Network Database Project (1993) The Vermont-Oxford Trials Network: very low birth weight outcomes for 1990. Pediatrics 91(3):540–545

    Google Scholar 

  3. Campbell M (1968) Natural history of persistent ductus arteriosus. Br Heart J 30:4–13

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Cotton RB, Stahlman MT, Kovar I et al (1978) Medical management of small preterm infants with symptomatic patent ductus arteriosus. J Pediatr 92:467–473

    Article  CAS  PubMed  Google Scholar 

  5. Hamrick SEG, Hansmann G (2010) Patent ductus arteriosus of the preterm infant. Pediatrics 125:1020–1030

    Article  PubMed  Google Scholar 

  6. Clyman RI (2000) Ibuprofen and patent ductus arteriosus. N Engl J Med 343:728–730

    Article  CAS  PubMed  Google Scholar 

  7. Van Overmeire B, Smets K, Lecoutere D et al (2000) A comparison of ibuprofen and indomethacin for closure of patent ductus arteriosus. N Engl J Med 343:674–681

    Article  PubMed  Google Scholar 

  8. Chorne N, Leonard C, Piecuch R et al (2007) Patent ductus arteriosus and its treatment as risk factors for neonatal and neurodevelopmental morbidity. Pediatrics 119:1165–1174

    Article  PubMed  Google Scholar 

  9. Raval M, Laughon MM, Bose CL et al (2007) Patent ductus arteriosus ligation in premature infants: who really benefits, and at what cost? J Pediatr Surg 42:69–75

    Article  PubMed  Google Scholar 

  10. Lee L, Tillett A, Tulloh R et al (2006) Outcome following patent ductus arteriosus ligation in premature infants: a retrospective cohort analysis. BMC Pediatr 6:15

    Article  PubMed Central  PubMed  Google Scholar 

  11. Gross R (1944) Complete surgical division of the patent ductus arteriosus: a report of fourteen successful cases. Surg Gynecol Obs 78:36–43

    Google Scholar 

  12. Children’s Hospital Association, Inc. (2012) http://www.childrenshospitals.org/index.html. Accessed 7 Apr 2013

  13. Shackford SR, Kahl JE, Calvo RY et al (2013) Limb salvage after complex repairs of extremity arterial injuries is independent of surgical specialty training. J Trauma Acute Care Surg 74:716–723

    Article  PubMed  Google Scholar 

  14. Borenstein SH, To T, Wajja A et al (2005) Effect of subspecialty training and volume on outcome after pediatric inguinal hernia repair. J Pediatr Surg 40:75–80

    Article  PubMed  Google Scholar 

  15. Pranikoff T, Campbell BT, Travis J et al (2002) Differences in outcome with subspecialty care: pyloromyotomy in North Carolina. J Pediatr Surg 37:352–356

    Article  PubMed  Google Scholar 

  16. Somme S, To T, Langer JC (2007) Effect of subspecialty training on outcome after pediatric appendectomy. J Pediatr Surg 42:221–226

    Article  PubMed  Google Scholar 

  17. Schipper PH, Diggs BS, Ungerleider RM et al (2009) The influence of surgeon specialty on outcomes in general thoracic surgery: a national sample 1996 to 2005. Ann Thorac Surg 88:1566–1572

    Article  PubMed  Google Scholar 

  18. Hutchings K, Vasquez A, Price D et al (2013) Outcomes following neonatal patent ductus arteriosus ligation done by pediatric surgeons: a retrospective cohort analysis. J Pediatr Surg 48:915–918

    Article  PubMed  Google Scholar 

  19. Mandhan P, Brown S, Kukkady A et al (2009) Surgical closure of patent ductus arteriosus in preterm low birth weight infants. Congenit Heart Dis 4:34–37

    Article  PubMed  Google Scholar 

  20. Zbar RI, Chen a H, Behrendt DM et al (1996) Incidence of vocal fold paralysis in infants undergoing ligation of patent ductus arteriosus. Ann Thorac Surg 61:814–816

    Article  CAS  PubMed  Google Scholar 

  21. Tyson J, Parikh N, Langer J et al (2008) Intensive care for extreme prematurity—moving beyond gestational age. New Engl J Med 358:1672–1681

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Best WR, Khuri SF, Phelan M et al (2002) Identifying patient preoperative risk factors and postoperative adverse events in administrative databases: results from the Department of Veterans Affairs National Surgical Quality Improvement Program. J Am Coll Surg 194:257–266

    Article  PubMed  Google Scholar 

  23. Benjamin JR, Smith PB, Cotten CM et al (2010) Long-term morbidities associated with vocal cord paralysis after surgical closure of a patent ductus arteriosus in extremely low birth weight infants. J Perinatol 30:408–413

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Sachdeva R, Hussain E, Moss MM et al (2007) Vocal cord dysfunction and feeding difficulties after pediatric cardiovascular surgery. J Pediatr 151:312–315

    Article  PubMed  Google Scholar 

  25. Clement WA, El-Hakim H, Phillipos EZ et al (2008) Unilateral vocal cord paralysis following patent ductus arteriosus ligation in extremely low-birth-weight infants. Arch Otolaryngol Head Neck Surg 134:28–33

    Article  PubMed  Google Scholar 

  26. Pereira KD, Webb BD, Blakely ML et al (2006) Sequelae of recurrent laryngeal nerve injury after patent ductus arteriosus ligation. Int J Pediatr Otorhinolaryngol 70:1609–1612

    Article  PubMed  Google Scholar 

  27. Herbst MA, Mercer BM, Beazley D et al (2003) Relationship of prenatal care and perinatal morbidity in low-birth-weight infants. Am J Obstet Gynecol 189:930–933

    Article  PubMed  Google Scholar 

  28. Cotten CM, Oh W, McDonald S et al (2005) Prolonged hospital stay for extremely premature infants: risk factors, center differences, and the impact of mortality on selecting a best-performing center. J Perinatol 25:650–655

    Article  PubMed  Google Scholar 

  29. Echtler K, Stark K, Lorenz M et al (2010) Platelets contribute to postnatal occlusion of the ductus arteriosus. Nat Med 16:75–82

    Article  CAS  PubMed  Google Scholar 

  30. Rothenberg SS, Chang JH, Toews WH et al (1995) Thoracoscopic closure of patent ductus arteriosus: a less traumatic and more cost-effective technique. J Pediatr Surg 30:1057–1060

    Article  CAS  PubMed  Google Scholar 

  31. Burke RP, Jacobs JP, Cheng W et al (1999) Video-assisted thoracoscopic surgery for patent ductus arteriosus in low birth weight neonates and infants. Pediatrics 104:227–230

    Article  CAS  PubMed  Google Scholar 

  32. Bianchi A, Sowande O, Alizai NK et al (1998) Aesthetics and lateral thoracotomy in the neonate. J Pediatr Surg 33:1798–1800

    Article  CAS  PubMed  Google Scholar 

  33. Vanamo K, Berg E, Kokki H et al (2006) Video-assisted thoracoscopic versus open surgery for persistent ductus arteriosus. J Pediatr Surg 41:1226–1229

    Article  PubMed  Google Scholar 

  34. Grimes DA, Schulz KF (2002) Descriptive studies: what they can and cannot do. Lancet 359:145–149

    Article  PubMed  Google Scholar 

  35. Albanese MA, Mejicano G, Mullan P et al (2008) Defining characteristics of educational competencies. Med Educ 42:248–255

    Article  PubMed  Google Scholar 

  36. Govaerts MJB (2008) Educational competencies or education for professional competence? Med Educ 42:234–236

    Article  PubMed  Google Scholar 

  37. Poley S, Ricketts T, Belsky D et al (2010) Pediatric surgeons: subspecialists increase faster than generalists. Bull Am Coll Surg 95:35–38

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Pediatrics, Connecticut Children’s Medical Center, Hartford, CT, USA

    Dor Markush & Amy C. Wu

  2. Department of Pediatric Surgery, Connecticut Children’s Medical Center, 282 Washington Street, 2G, Hartford, CT, 06106, USA

    Kelleigh E. Briden, Michael Chung & Brendan T. Campbell

  3. Department of Research, Connecticut Children’s Medical Center, Hartford, CT, USA

    Katherine W. Herbst, Trudy J. Lerer & Stephen Neff

Authors
  1. Dor Markush
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kelleigh E. Briden
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Katherine W. Herbst
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Trudy J. Lerer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stephen Neff
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Amy C. Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Brendan T. Campbell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brendan T. Campbell.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Markush, D., Briden, K.E., Chung, M. et al. Effect of surgical subspecialty training on patent ductus arteriosus ligation outcomes. Pediatr Surg Int 30, 503–509 (2014). https://doi.org/10.1007/s00383-014-3469-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-014-3469-y

Keywords

Search

Navigation