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Resection of pediatric lung malformations: National trends in resource utilization & outcomes
Amy E Wagenaar1, Jun Tashiro1, Shevonne S Satahoo1
1Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Insights
Surgical resection of congenital lung malformations (CLM) has high survival rates. Younger children (<3 months) had worse outcomes, but thoracoscopic surgery showed no difference in results compared to open procedures.
Area of Science:
- Pediatric surgery
- Thoracic surgery
- Congenital lung malformations
Background:
- Congenital lung malformations (CLM) are a spectrum of developmental abnormalities.
- Surgical resection is the primary treatment for symptomatic CLM.
- Understanding factors influencing outcomes is crucial for patient management.
Purpose of the Study:
- To identify factors affecting survival and resource use in pediatric patients undergoing CLM resection.
- To compare thoracoscopic versus open surgical approaches using propensity score-matched analysis (PSMA).
Main Methods:
- Analysis of the Kids' Inpatient Database (1997-2009).
- Inclusion of patients with congenital pulmonary airway malformation (CPAM) and pulmonary sequestration (PS) undergoing resection.
- Propensity score-matched analysis (PSMA) to compare thoracoscopic and open CPAM resections.
Main Results:
- Overall in-hospital survival was 97%.
- Younger children (<3 months) had higher mortality, transfusion rates, and length of stay (LOS), but higher rates of pneumothorax (PTX) and thoracoscopic procedures.
- Multivariate analysis indicated longer LOS for older and Medicaid patients; higher total charges (TC) for Western U.S., older, and Medicaid patients.
- PSMA revealed no significant difference in outcomes between thoracoscopic and thoracotomy approaches for CPAM.
Conclusions:
- CLM resection is associated with high survival.
- Younger age (<3 months) is linked to increased mortality, transfusion, and thoracotomy rates.
- Socioeconomic status, age, and region independently influence resource utilization.
- Extent of resection is a prognostic indicator for survival.
- Thoracoscopic resection does not negatively impact outcomes compared to open surgery.
Purpose:
We sought to determine factors influencing survival and resource utilization in patients undergoing surgical resection of congenital lung malformations (CLM). Additionally, we used propensity score-matched analysis (PSMA) to compare these outcomes for thoracoscopic versus open surgical approaches.
Methods:
Kids' Inpatient Database (1997-2009) was used to identify congenital pulmonary airway malformation (CPAM) and pulmonary sequestration (PS) patients undergoing resection. Open and thoracoscopic CPAM resections were compared using PSMA.
Results:
1547 cases comprised the cohort. In-hospital survival was 97%. Mortality was higher in small vs. large hospitals, p<0.005. Survival, pneumothorax (PTX), and thoracoscopic procedure rates were higher, while transfusion rates and length of stay (LOS) were lower, in children ≥3 vs. <3months (p<0.001). Multivariate analysis demonstrated longer LOS for older patients and Medicaid patients (all p<0.005). Total charges (TC) were higher for Western U.S., older children, and Medicaid patients (p<0.02). PSMA for thoracoscopy vs. thoracotomy in CPAM patients showed no difference in outcomes.
Conclusion:
CLM resections have high associated survival. Children <3months of age had higher rates of thoracotomy, transfusion, and mortality. Socioeconomic status, age, and region were independent indicators for resource utilization. Extent of resection was an independent prognostic indicator for in-hospital survival. On PSMA, thoracoscopic resection does not affect outcomes.
