Changing patterns of patent ductus arteriosus surgical ligation in the United States

Abstract

Optimal management of patent ductus arteriosus (PDA) is unclear. One treatment, surgical ligation, is associated with adverse outcomes. We reviewed data from the Kids' Inpatient Database (2000-2012) to determine if PDA ligation rates: (1) changed over time, (2) varied geographically, or (3) influenced surgical complication rates. In 2012, 47,900 infants <1500g birth weight were born in the United States, including 2,800 undergoing PDA ligation (5.9%). Ligation was more likely in infants <1000g (85.9% vs. 46.2%), and associated with necrotizing enterocolitis (59.2% vs. 37.5%), BPD (54.6% vs. 15.2%), severe intraventricular hemorrhage (16.4% vs. 5.3%), and hospital transfer (37.6% vs. 16.4%). Ligation rates peaked in 2006 at 87.4 per 1000 hospital births, dropping to 58.8 in 2012, and were consistently higher in Western states. Infants undergoing ligation were more likely to experience comorbidities. Rates of ligation-associated vocal cord paralysis increased over time (1.2-3.9%); however, mortality decreased (12.4-6.5%). Thus, PDA ligation has become less frequent, although infants being ligated are smaller and more medically complex. Despite increase in some complications, mortality rates improved perhaps reflecting advances in care.

Keywords: Patent ductus arteriosus; geographic variation; kids' inpatient database; surgical ligation; vocal cord paralysis.

Fig. 1 -

PDA surgical ligation rate per 1000 VLBW hospital births, US 2000–2012. PDA ligation rate (per 1000 VLBW hospital births), 2000: 46.8 (95% CI: 42.8–50.0); 2003: 65.7 (95% CI: 61.7–69.2); 2006 87.4 (95% CI: 81.2–92.9); 2009 78.5 (95% CI: 72.9–83.5); 2012 58.8 (95% CI: 54.6–62.6).

Fig. 2 -

PDA surgical ligation rate per 1000 VLBW hospital births by US geographic region, 2000–2012.