Abstract 12502: Transcatheter Patent Ductus Arteriosus Closure is Associated With Improved Outcomes Compared to Surgical Ligation

Abstract

Introduction: Pharmacologic therapy for closure of a patent ductus arteriosus is not consistently successful. Surgical ligation (SL) or transcatheter closure (TC) may be needed. Large multi-center analyses comparing outcomes and resource utilization between SL and TC are lacking. We hypothesized that patients undergoing TC have improved outcomes compared to SL including mortality, length of stay (LOS), intensive care unit (ICU) admission, and ventilation. Methods: Using the 2016-2020 Pediatric Health Information System database, characteristics, outcomes, and charges of patients less than 1 year who underwent TC or SL were analyzed. Results: 678 inpatients undergoing TC (n=503) or SL (n=175) were identified. Surgical patients were younger (0.1 vs 0.53 yrs; P<0.001) and more premature (60% vs 20.3%; P<0.001). Comorbidities were more prevalent among SL patients: bronchopulmonary dysplasia (28.6% vs 16.3%; P<0.001), necrotizing enterocolitis (9.7% vs 0.4%; P<0.001), intraventricular hemorrhage (21.7% vs 2.4%; P<0.001), sepsis (11.4% vs 0.6%; P<0.001), and renal insufficiency (7.4% vs 0.8%; P<0.001). Over time, TC represented an increasing proportion of cases (Figure 1). In-hospital mortality for TC was 0% vs 1.7%; P=0.02. Using inverse probability of treatment weighting by the propensity score, multivariable adjusted analyses demonstrated favorable outcomes in TC: ICU admission rates (adjusted odds ratio (aOR): 0.2; 95% CI: 0.11, 0.32; P<0.001); mechanical ventilation (aOR: 0.3; 95% CI: 0.19, 0.56; P<0.001); and shorter hospital (adjusted coefficient: 2 days shorter; 95% CI: 1.3, 2.7; P<0.001) and postoperative (adjusted coefficient: 1.2 days shorter; 95% CI: 0.1, 2.3; P=0.039) LOS. Overall charges (adjusted coefficient: -$13,100, 95% CI: -26,400, 200; P=0.06) and readmission rates were similar. Conclusions: TC is associated with better outcomes including mortality and LOS. Rates of TC continue to increase compared to SL.