Trends in Ductus Arteriosus Stent Versus Blalock‐Taussig‐Thomas Shunt Use and Comparison of Cost, Length of Stay, and Short‐Term Outcomes in Neonates With Ductal‐Dependent Pulmonary Blood Flow: An Observational Study Using the Pediatric Health Information Systems Database

Abstract

Background The modified Blalock‐Taussig‐Thomas shunt is the gold standard palliation for securing pulmonary blood flow in infants with ductal‐dependent pulmonary blood flow. Recently, the ductus arteriosus stent (DAS) has become a viable alternative. Methods and Results This was a retrospective multicenter study of neonates ≤30 days undergoing DAS or Blalock‐Taussig‐Thomas shunt placement between January 1, 2017 and December 31, 2020 at hospitals reporting to the Pediatric Health Information Systems database. We performed generalized linear mixed‐effects modeling to evaluate trends in intervention and intercenter variation, propensity score adjustment and inverse probability weighting with linear mixed‐effects modeling to analyze length of stay and cost of hospitalization, and generalized linear mixed modeling to analyze differences in 30‐day outcomes. There were 1874 subjects (58% male, 61% White) from 45 centers (29% DAS). Odds of DAS increased with time (odds ratio [OR] 1.23, annually, P <0.01 [95% CI, 1.10–1.38]) with significant intercenter variation (median OR, 3.81 [95% CI, 2.74–5.91]). DAS was associated with shorter hospital length of stay (ratio of geometric means, 0.76 [95% CI, 0.63–0.91]), shorter intensive care unit length of stay (ratio of geometric means, 0.77 [95% CI, 0.61–0.97]), and less expensive hospitalization (ratio of geometric means, 0.70 [95% CI, 0.56–0.87]). Intervention was not significantly associated with odds of 30‐day transplant‐free survival (OR,1.18 [95% CI, 0.70–1.99]) or freedom from catheter reintervention (OR, 1.02 [95% CI, 0.65–1.58]), but DAS was associated with 30‐day freedom from composite adverse outcome (OR, 1.51 [95% CI, 1.11–2.05]). Conclusions Use of DAS is increasing, but there is variability across centers. Though odds of transplant‐free survival and reintervention were not significantly different after DAS, and DAS was associated with shorter length of stay and lower in‐hospital costs.