Mulago National Teaching and Referral Hospital, Uganda
Posters & Accepted Abstracts: Surgery Curr Res
Background: There is clinical equipoise regarding post-operative management of patients with patent ductus arteriosus (PDA) without insertion of a chest drain. Objective: This study evaluated post-operative outcomes of chest closure with or without a drain following patent ductus arteriosus ligation among children at Uganda Heart Institute. Method: This was an open label randomized controlled trial of 62 children of 12 years of age and diagnosed with patent ductus arteriosus at Mulago National Teaching and Referral Hospital, Uganda. Participants were randomized in the ratio of 1:1 with surgical ligation of patent ductus arteriosus to either thoracotomy closure with a chest tube or without a chest tube. All participants received standard care and were monitored hourly for 24 hours then until hospital discharge. The combined primary endpoint consisted of significant pleural space accumulation of fluid or air, higher oxygen need or infection of the surgical site. Analysis was conducted by multivariable logistic regression analysis at 5% significance level. Results: We enrolled 62 participants, 46 (74%) of whom were females. Their median age was 12 months (IQR: 8-36). Participants in the no-drain arm significantly had less post-operative complications compared to the drain arm (Unadjusted odds ratio [uOR]: 0.21, 95% CI: 0.06-0.73, p=0.015). This â??protective effectâ? remained without statistical significance in the multivariable regression model (Adjusted odds ratio [aOR]: 0.07, 95% CI: 0.00-2.50, p=0.144). Conclusion: Children aged below six years with patent ductus arteriosus can safely and effectively have thoracotomy closure without using a drain in uncomplicated surgical ligation of the PDA. Chest drain was associated with post-operative complications.
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