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Patent ductus arteriosus ligation: are we doing better?
W M Novick1, D C Watson, B S Alpert
1Department of Pediatric Cardiology, LeBonheur Children's Medical Center, University of Tennessee, Memphis.
Insights
Surgical outcomes for patent ductus arteriosus ligation in children over 3 months old improved significantly after 1991. Perioperative length of stay and hospital charges decreased without increased morbidity.
Area of Science:
- Pediatric Surgery
- Health Economics
Background:
- Healthcare resource limitations necessitate re-evaluation of preoperative standards.
- Patent ductus arteriosus (PDA) ligation is a common pediatric surgical procedure.
Purpose of the Study:
- To assess changes in perioperative care efficiency and cost for PDA ligation in children older than 3 months.
- To determine if efficiency improvements impacted patient outcomes.
Main Methods:
- Retrospective review of clinical and financial records for children undergoing PDA ligation (July 1984 - April 1994).
- Patients with isolated PDA, >3 months old, and no complications were stratified into two groups based on operation date (pre- vs. post-January 1, 1991).
- Analysis of age, length of stay, readmissions, and adjusted hospital charges.
Main Results:
- A significant reduction in perioperative length of stay was observed in Group II (2.7 days) compared to Group I (3.9 days) (p < 0.0001).
- Hospital charges were significantly lower in Group II ($6,600) versus Group I ($8,700) (p < 0.0001).
- No increase in postdischarge morbidity was noted.
Conclusions:
- Elective patent ductus arteriosus ligation in children over 3 months has become more efficient and cost-effective.
- Improved perioperative care standards have been implemented without compromising patient safety or increasing complications.
- These findings support evidence-based adjustments to surgical care protocols in response to healthcare policy.
Abstract:
Limitation on health care resource use is stimulating critical evaluation of previous preoperative standards. We retrospectively reviewed the clinical and hospital financial records of all children admitted for patent ductus arteriosus ligation from July 1984 to April 1994 for age, perioperative length of stay, readmissions for postoperative surgical problem, and hospital charges adjusted to 1994 dollars. Patients with an isolated patent ductus arteriosus, greater than 3 months of age, without preoperative or postoperative complications were included in this study and stratified into two groups based on date of operation. Group I had operation before January 1, 1991, and group II had operation on or after January 1, 1991. Comparison of these two groups revealed a significant difference in perioperative length of stay (group I, 3.9 +/- 1.2 days [mean +/- standard deviation]; group II, 2.7 +/- 0.9 days; p < 0.0001) and in hospital charges (group I, $8,700 +/- $2,100; group II, $6,600 +/- $1,000; p < 0.0001). These data support the premise that children older than 3 months undergoing elective ligation of a patent ductus arteriosus have been treated with improved efficiency and less charge without an increase in postdischarge morbidity. Health care policy decisions have forced us to evaluate the standards of perioperative care more critically.