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

Lisa K. Lee, Michelle Y. Woodfin, Marissa Vadi, Tristan R. Grogan, Phillip J. Ross, Richard Lee Applegate, Marc Iravani

Research output: Contribution to journalArticle

Abstract

Background: Although 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. Methods: We 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. Results: Data 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). Conclusion: PDA 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. Patent ductus arteriosus, Newborn infant, Neonatal intensive care unit, Surgical wound infection, Postoperative period, Hemodynamics.

Original languageEnglish (US)
Article number199
JournalBMC Anesthesiology
Volume18
Issue number1
DOIs
StatePublished - Dec 22 2018

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Patent Ductus Arteriosus
Neonatal Intensive Care Units
Ligation
Cohort Studies
Retrospective Studies
Operating Rooms
Surgical Wound Infection
Hemodynamics
Mortality
Odds Ratio
Incidence
Sepsis
Heart Arrest
Hypothermia
Postoperative Period
Multicenter Studies
Comorbidity
Newborn Infant
Safety
Weights and Measures

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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A comparison of postoperative outcomes with PDA ligation in the or versus the NICU : A retrospective cohort study on the risks of transport. / Lee, Lisa K.; Woodfin, Michelle Y.; Vadi, Marissa; Grogan, Tristan R.; Ross, Phillip J.; Applegate, Richard Lee; Iravani, Marc.

In: BMC Anesthesiology, Vol. 18, No. 1, 199, 22.12.2018.

Research output: Contribution to journalArticle

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abstract = "Background: Although 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. Methods: We 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. Results: Data 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). Conclusion: PDA 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. Patent ductus arteriosus, Newborn infant, Neonatal intensive care unit, Surgical wound infection, Postoperative period, Hemodynamics.",
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