Transcatheter Closure of PDA Compared to Surgical Ligation in Premature Neonates: Clinical Outcomes and Cost Comparison
Presenter
Hitesh Agrawal, MD, MBA, FSCAI, Dell Children's Hospital, Austin, TX
Hitesh Agrawal, MD, MBA, FSCAI1, Sarah Parkerson, MD2, Donald E Lighter, MD, MBA3, Jay H Fowke, PhD, MPH, MS4, Patricia J Goedecke, MS4, Jeffrey A Towbin, MD2, Benjamin R. Waller III, M.D.5, Christopher J Knott-Craig, MD6 and Shyam K. Sathanandam, M.D., FSCAI5, (1)Dell Children's Hospital, Austin, TX, (2)University Of Tennessee /Le Bonheur Children's Medical Center, Memphis, TN, (3)The University of Tennessee, Knoxville, TN, (4)The University of Tennessee Health Science Center, Memphis, TN, (5)Le Bonheur Children's Hospital, Memphis, TN, (6)Lebonheur Children's Hospital, Memphis, TN
Keywords: Complications and Quality
Background
Surgical and transcatheter closure of patent ductus arteriosus (PDA) are both effective strategies in premature neonates but the clinical outcomes and the economic impact of these therapeutic modalities is unknown.
Methods
A
retrospective study of premature infants weighing <2.5kg who underwent surgical PDA ligation (between 2008-2014) or transcatheter PDA closure (2014-2019) at a large regional hospital. Total and department-specific inpatient costs during the index hospitalization were estimated from the Pediatric Health Information System, adjusted for inflation to 2019 dollars, and log transformed to meet the normality assumption. Complications were defined as untoward events requiring further interventions or causing death. Analyses included t-tests and chi square tests for continuous and categorical variables, respectively. Because this hospital is a referral center, all analyses were stratified by those patients who
Transferred back to the referring facility following index procedure versus
In-House patients who stayed in the NICU until hospital discharge or mortality.
Results
The study cohort included 167 patients who underwent surgical
PDA ligation and 107 who had transcatheter PDA closure. Among
Transfer patients, baseline demographic and clinical characteristics were similar between the two groups. In the
In-House category however, median weight at procedure was significantly lower in the surgical group compared to the transcatheter group {960 gm (range 560-2480) versus 1190 gm (640-2500), respectively, p < 0.001}. The mean total inflation adjusted 2019 cost was similar between the surgical and transcatheter groups for both
Transfer ($40,384 versus $34,419, p=0.29) and
In-House ($400,670 versus $374,701, p=0.15) patients. The surgical group had higher lab and pharmacy costs, while transcatheter procedures had higher imaging cost. The overall complication rate was significantly higher in the surgical compared to the transcatheter group {43/167 (25.7%); 8/107 (7.5%), respectively, p < 0.001}.
Conclusions
Given the high complication rates associated with surgical PDA ligation, transcatheter appears to be a safer and cost-equivalent alternative for this extremely vulnerable population.