The Incidence of and Factors Associated With Adverse Post-operative Outomes Following Open Surgical Ligation of Patent Ductus Arteriosus at the Kenyatta National Hospital, Kenya

Abstract

Background Open surgical ligation of patent ductus arteriosus (PDA) has been shown to be associated with adverse outcomes in some observational studies. However, new evidence is suggesting that open surgical ligation of a PDA may not increase adverse outcomes. Objectives To determine the incidence of, and factors associated with the occurrence of adverse post-operative outcomes after open surgical ligation of a PDA. Methodology We conducted a retrospective observational cohort study over a 10-year period using consecutive sampling method. Risk factors and predictors of adverse post-operative outcomes were analysed using cross tabulation and logistic regression analysis. Statistical significance was set at P≤0.05 at 95% confidence interval. Results The mean gestational age at birth was 36.72 ± 3.96 weeks. The median age at surgical ligation of PDA was 12 (IQR: 7, 22.5) months. Incidence of residual shunt at one-month post-operative was 15%. Chest infection within 3 weeks prior to surgical ligation and chest tube insertion correlated for adverse post-operative outcomes with Odds ratios of 4.1026 and 8.1535 respectively. Conclusion Open surgical ligation of the PDA is a relatively very safe procedure with minimal risk in our setup. The insertion of a chest tube before chest closure seemed to be associated with risk of the requirement for haemodynamic and ventilatory support. Chest infection within 3 prior to surgical ligation was predictive of hospital stay longer than 7 days