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Outcomes of surgical treatment for hemangiomas
Jeffrey Cheng1, Beiyu Liu2, Hui-Jie Lee2
1Pediatric Otolaryngology, Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Insights
Surgical excision of hemangiomas in children is a relatively safe option when medical therapy fails. Older children (over 3 years) experienced fewer adverse surgical events, with overall complication rates being low.
Area of Science:
- Pediatric Surgery
- Dermatology
- Vascular Anomalies
Background:
- Infantile hemangiomas are common benign vascular tumors in children.
- Medical therapy is the first-line treatment, but some cases require surgical intervention.
- Assessing surgical risks is crucial for guiding treatment decisions.
Purpose of the Study:
- To evaluate the safety and complication rates of surgical hemangioma excision in pediatric patients.
- To identify risk factors associated with adverse events after surgery for hemangiomas.
Main Methods:
- Utilized the American College of Surgeons (ACS) National Surgical Quality Improvement Program (ACS NSQIP® -pediatric) database from 2012-2016.
- Included 1180 pediatric patients (under 18 years) diagnosed with hemangioma (ICD-9: 228.00, 228.01; ICD-10: D18.00, D18.01).
- Performed multivariate analysis to identify predictors of adverse events.
Main Results:
- No cases of deep incisional surgical site infection, nerve injury, mortality, sepsis, septic shock, or bloodstream infections were reported.
- Younger age (≤ 3 years) and higher American Society of Anesthesiologists (ASA) class were significant predictors of adverse events.
- Children older than 3 years had a lower incidence of surgical adverse events.
Conclusions:
- Surgical resection is a viable and relatively safe alternative for pediatric hemangiomas unresponsive to medical treatment.
- Age is a key factor, with older children experiencing better surgical outcomes.
- Overall, surgical complication rates for pediatric hemangiomas are low and generally minor.
Objective:
To quantify complications and rates of adverse events associated with surgical excision of hemangiomas in children using a national surgical database.
Data Source:
Pediatric American College of Surgeons (ACS) National Surgical Quality Improvement Program® (ACS NSQIP® -pediatric), years 2012-2016.
Methods:
Subjects included children under 18 years with a postoperative diagnosis of International Classification of Diseases (ICD), 9th revision code: 228.00 and 228.01, or ICD 10 codes D18.00 and D18.01-hemangioma, any site and hemangioma, of skin and subcutaneous tissue.
Results:
A total of 1180 patients were included. The median age was 3.2 years (interquartile range [IQR] 1.2 to 6.4 years old). No occurrences of deep incisional surgical site infection, nerve injury, mortality, sepsis, septic shock, or blood stream infections were noted. In multivariate analysis, age ≤ 3 years and advanced American Society of Anesthesiologists class were significant predictors of adverse events (P = 0.035 and 0.001, respectively).
Conclusions:
For children with infantile hemangioma who fail to respond or have an incomplete response to medical therapy, surgical resection may be a relatively safe treatment alternative. Children older than 3 years of age with hemangiomas had less surgical adverse events than younger children. Overall, however, the surgical complications rates were low and deemed relatively minor.
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