Ann Thorac Surg 1995;59:824
© 1995 The Society of Thoracic Surgeons
Discussion
DISCUSSION
See also page 822.
DR CHRISTOPHER J. KNOTT-CRAIG (Oklahoma City, OK): Thank you for sending the manuscript to me before this meeting. Over the past 18 months we too have had a change in attitude regarding patients with PDA: We have them admitted the day of the operation and employ a muscle-sparing minithoracotomy through which we obliterate the ductus. The patients return to the ward after the operation; we do not put in a chest tube but follow them up with serial roentgenograms. The average length of stay of these patients over the past 14 months was 2 to 3 days and the total hospital cost involved was $4,980, which represents a 42% reduction over the preceding period. More recently, we began admitting the patients the morning of operation and discharging them usually within a day or a day and a half of the admission.
I would like to ask you two questions. Because we probably have reached the stage where it is going to be difficult to reduce the hospital stay and hospital costs much further, how do you think the introduction of video-assisted thoracoscopic closure of the PDAs or catheter ablation of the PDAs is going to affect this practice, and do you think these will represent further cost savings for the patients?
DR WATSON: Thank you, Dr Knott-Craig. I appreciate your comments. We also are continuing to test the boundaries of what we are able to do, and I would say that our aim now is to have patients admitted the day of operation, receive an operation, stay in the hospital until the next morning when the chest tube is removed, and be discharged that afternoon. So it is possible, even likely, that the hospital stay will be less than 2 days. Your questions had to do with video-assisted thoracic surgery. I am still a little anxious about manipulating vascular structures with video-assisted thoracic surgery. We have not decided to take that step and ligate PDAs with video-assisted thoracic surgery. There have been efforts elsewhere to occlude PDAs with ductal devices. There is a recent experience reported in the New England Journal of Medicine (November 1993) where results were not improved but costs were greater. So we have not taken that step.
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Patent Ductus Arteriosus Ligation: Are We Doing Better?
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Ann. Thorac. Surg. 1995 59: 822-824.
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