Fast track pediatric thoracic surgery: Toward day-case surgery?

Area of Science:

• Pediatric Thoracic Surgery
• Minimally Invasive Surgery
• Congenital Pulmonary Airway Malformation

Background:

• Thoracoscopic lung resection is a safe surgical approach for pediatric congenital pulmonary airway malformation (CPAM).
• Implementing fast-track protocols can potentially optimize postoperative care and reduce hospital stays.

Purpose of the Study:

• To evaluate the feasibility and outcomes of a fast-track protocol for pediatric patients undergoing thoracoscopic lung resection for CPAM.
• To assess the impact of fast-track protocols on postoperative hospital stay, complication rates, and the potential for day-case surgery.

Main Methods:

• Retrospective review of 101 patients undergoing thoracoscopic pulmonary resection, with 83 for CPAM, from September 2007 to May 2016.
• Analysis of surgical procedures, postoperative management, and complications across three distinct time periods with evolving fast-track protocols.
• Comparison of outcomes, including hospital stay and complication rates, between different management protocols.

Main Results:

• Median postoperative hospital stay significantly decreased across the three time periods (4, 3, and 2 days, P=0.02).
• In the latest period, 4 patients were managed as day-case surgeries.
• Overall and surgical complication rates remained stable (14% and 10%, respectively), with air leakage being the primary concern.

Conclusions:

• A fast-track protocol for uncomplicated pediatric thoracic surgery for CPAM is feasible and does not increase morbidity.
• Selected patients undergoing thoracoscopic resection for CPAM can benefit from the absence of pleural drainage and may be suitable for day-case surgery.