Comparison of 30-day outcomes between thoracoscopic and open lobectomy for congenital pulmonary lesions

To compare postoperative length of stay and 30-day outcomes between thoracoscopic and open lobectomy performed on a nonemergency basis for congenital pulmonary lesions using a validated national database.

We identified all nonemergency lobectomies performed on patients with congenital pulmonary lesions in the 2012 National Surgical Quality Improvement Program (NSQIP) Pediatric database and compared demographic, clinical, and 30-day outcome characteristics between patients who underwent an open or thoracoscopic lobectomy. Logistic regression with Firth's penalized likelihood bias-reduction method was used to determine predictive risk factors for a postoperative length of stay (LOS) of >3 days.

Of 101 patients included, 40 (39%) underwent thoracoscopic lobectomy. In comparison with patients undergoing thoracoscopic lobectomy, patients undergoing open lobectomy were significantly more likely to be admitted prior to surgery, be American Society of Anesthesiologists Class ≥ 3, receive oxygen support prior to surgery, and have other congenital anomalies or cardiac risk factors. Both groups had similar total operative times (open versus thoracoscopic, 150 versus 173 minutes; P=.216). Patients undergoing open lobectomy had longer postoperative LOS (4 versus 3 days; P=.001) and more often received an intraoperative or postoperative transfusion (12% versus 0%; P=.003). The procedure type was not an independent risk factor for postoperative LOS >3 days in the multivariable analysis.

Patients undergoing thoracoscopic lobectomy have fewer comorbidities at baseline, receive fewer perioperative transfusions, and have a shorter postoperative LOS. Accrual of additional patients within the NSQIP Pediatric database will allow for further risk-adjusted analyses to control for differences in baseline characteristics between patients undergoing open and thoracoscopic resections.