Outcomes of Abdominal Intestinal Surgery in Preterm Infants with Patent Ductus Arteriosus: A Multicenter Retrospective Cohort Study

Background/objectives: Patent ductus arteriosus (PDA) is associated with intestinal hypoperfusion in preterm infants, but whether a patent ductus at the time of abdominal surgery affects surgical outcomes is unknown. Methods: This multicenter retrospective cohort study included 100 abdominal intestinal procedures in 62 preterm infants at five tertiary hospitals (2017–2024). Each procedure was classified by ductal status at the time of surgery as performed with an echocardiographically confirmed patent ductus (n = 43 procedures in 38 infants), after ductal closure by ligation, pharmacologic treatment, or spontaneous closure (n = 33 in 28 infants), or in infants in whom PDA was never diagnosed (control, n = 24 in 15 infants). The primary outcome was any postoperative complication. Procedure-level outcomes were analyzed with generalized estimating equations accounting for repeated procedures within infants and adjusted for gestational age; death and bronchopulmonary dysplasia were analyzed at the infant level. Results: Procedures with a patent ductus were performed in more immature infants (median gestational age 26 + 6 vs. 31 + 6 weeks in controls, p < 0.001). Postoperative complications (25.6% vs. 25.0%; adjusted odds ratio [OR] 1.50, 95% CI 0.34–6.63) and reoperation (16.3% vs. 16.7%; adjusted OR 1.32, 95% CI 0.21–8.43) did not differ between procedures with a patent ductus and controls. Postoperative hospital stay was longer after procedures with a patent ductus (median 92 vs. 52 days), but this difference was attenuated after adjustment (ratio of geometric means 1.30, 95% CI 0.62–2.70). In-hospital death occurred in 8 of 37 infants whose first procedure was performed with a patent ductus and in 1 of 15 controls (adjusted OR 0.75, 95% CI 0.09–9.03). Growth through 36 months of corrected age did not differ significantly, but follow-up was incomplete. Results were consistent when stoma takedowns were excluded and when only the first procedure per infant was analyzed. Conclusions: In preterm infants undergoing abdominal intestinal surgery, a patent ductus at the time of surgery was not associated with higher rates of postoperative complications or reoperation. Differences in mortality and hospital stay were attenuated after adjustment for gestational age but remain uncertain given the small number of events. These observational findings do not establish that PDA has no clinically relevant effect on surgical outcomes.