A comparison of postoperative outcomes with PDA ligation in the OR versus the NICU: a retrospective cohort study on the risks of transport

Abstract

BackgroundAlthough patent ductus arteriosus (PDA) ligations in the Neonatal Intensive Care Unit (NICU) have been an accepted practice, many are still performed in the Operating Room (OR). Whether avoiding transport leads to improved perioperative outcomes is unclear. Here we aimed to determine whether PDA ligations in the NICU corresponded to higher risk of surgical site infection or mortality and if transport was associated with worsened perioperative outcomes.MethodsWe performed a retrospective cohort study of NICU patients, ≤37 weeks post-menstrual age, undergoing surgical PDA ligation in the NICU or OR. We excluded any infants undergoing device PDA closure. We measured the incidence of perioperative hypothermia, cardiac arrest, decreases in SpO2, hemodynamic instability and postoperative surgical site infection, sepsis and mortality.ResultsData was collected on 189 infants (100 OR, 89 NICU). After controlling for number of preoperative comorbidities, weight at time of procedure, procedure location and hospital in the mixed-effect model, no significant difference in mortality or sepsis was found (odds ratio 0.31, 95%CI 0.07, 1.30; p = 0.107, and odds ratio 0.40; 95%CI 0.14, 1.09; p = 0.072, respectively). There was an increased incidence of hemodynamic instability on transport postoperatively in the OR group (12.4% vs 2%, odds ratio 6.93; 95% CI 1.48, 35.52; p = 0.014).ConclusionPDA ligations in the NICU were not associated with higher incidences of surgical site infection or mortality. There was an increased incidence of hemodynamic instability in the OR group on transport back to the NICU. Larger multicenter studies following long-term outcomes are needed to evaluate the safety of performing all PDA ligations in the NICU.KeywordsPatent ductus arteriosus, Newborn infant, Neonatal intensive care unit, Surgical wound infection, Postoperative period, Hemodynamics

An Update on Patent Ductus Arteriosus and What is Coming Next

“… 123 In a recent large multicenter retrospective study comparing PDA ligations in the operating room (OR) and the NICU, no differences in mortality or sepsis could be detected after correcting for differences in GA, besides an increased postoperative hemodynamic instability in the OR group. 124 Similar findings with no differences in mortality or complications after PDA ligation performed either in the OR or the NICU were presented in a 2-center retrospective cohort study from 2021, with a significantly earlier closure in the NICU group by 24 days. 125 …”

“…123 In a recent large multicenter retrospective study comparing PDA ligations in the operating room (OR) and the NICU, no differences in mortality or sepsis could be detected after correcting for differences in GA, besides an increased postoperative hemodynamic instability in the OR group. 124 Similar findings with no differences in mortality or complications after PDA ligation performed either in the OR or the NICU were presented in a 2-center retrospective cohort study from 2021, with a significantly earlier closure in the NICU group by 24 days. 125 The difficulty to define early hsPDA and the trend toward a less aggressive approach to treat PDA surgically during the last decade, have shown that postponing surgical treatment of late hsPDA in cases of failed medical treatment is both feasible and even safer in terms of reduced severe neurodevelopmental impairment.…”

“…In the preterm lung, there is a delicate balance between increased fluid infiltration induced by PDA and lung lymphatic fluid reabsorption. Any increase in pulmonary microvascular pressure can cause a sudden increase in interstitial and Turk Arch Pediatr 2022; 57(2): [118][119][120][121][122][123][124][125][126][127][128][129][130][131] Erdeve et al alveolar lung fluid because the premature newborn has low oncotic pressure and high capillary permeability. 72 This inadequate structural development and function of the pulmonary vessels is an important feature of BPD.…”

Anesthesia protocols for “bedside” preterm patent ductus arteriosus ligation: A single-institutional experience

“…Although the 30-day mortality and perioperative (procedure related) hemodynamic instability were comparable between PDA ligation in OR (5% and 38.2% respectively) as reported by Lee et al . [ 28 ] and those in our series (4.5% and 32% respectively), transport-related problems such as hemodynamic instability during shifting to (5.6%) and from (12.4%) the OR and hypothermia (<36°C) in the intraoperative (26.3%) or postoperative (12%) period were noted in patients with OR ligations. Wang et al .…”

An hybrid Operating Theater setting for major surgery in an Extremly Low Birth Weight Infants: a case report

“…Most of the literature describing bedside surgery report advantages and safety for the patients involved 3,4 . The main contraindication for bedside surgery is the lack of a dedicated area.…”