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Thoracotomy in Children: Review from a Low-Income Country
Hana Abebe Gebreselassie1, Mekdelawit Mesfin Tadesse2, Hanna Getachew Woldeselassie3
1Department of Surgery, Pediatrics Surgery Unit, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Insights
Pediatric thoracotomy for non-cardiac conditions in a low-income country showed pulmonary hydatid cyst as the main indication. The study highlighted suboptimal post-operative pain management and significant morbidity and mortality rates.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Global Health
Background:
- Thoracotomy is a critical surgical procedure for various pediatric congenital and acquired conditions.
- Implementing thoracotomy requires specialized teams, which are challenging to assemble in low-income countries.
- Data on the patterns and outcomes of pediatric thoracotomy in low-resource settings are scarce.
Purpose of the Study:
- To investigate the indications, approaches, and outcomes of pediatric thoracotomy in a low-income country.
- To analyze the post-operative pain management strategies employed.
- To determine the morbidity and mortality rates associated with pediatric thoracotomy in this setting.
Main Methods:
- A descriptive cross-sectional review of pediatric patients undergoing non-cardiac thoracotomy.
- Collection of demographic and clinical data through chart review.
- Analysis of categorical variables using frequencies and percentages, and continuous variables using descriptive statistics.
Main Results:
- A total of 68 pediatric patients underwent thoracotomy, with males constituting 64.7%.
- Pulmonary hydatid cyst (25%) and congenital lobar emphysema (16.2%) were the most frequent indications.
- Muscle sparing posterolateral thoracotomy was the predominant surgical approach (97.1%), with suboptimal post-operative analgesia and notable morbidity (11.8%) and mortality (8.8%) rates.
Conclusions:
- Pulmonary hydatid cyst is the leading indication for pediatric thoracotomy in this low-income setting.
- Post-thoracotomy analgesia was suboptimal, lacking regional blocks and multimodal approaches.
- Pediatric thoracotomy in this resource-limited environment is associated with considerable morbidity and mortality.
Background:
Thoracotomy is indicated for several congenital and acquired disorders in children. It is among the surgical procedures which require a well-trained and dedicated surgical, anesthesia and critical care team which can be difficult to assemble in a low-income country setup. As the pattern and outcome of thoracotomy in children remained unreported from such setting, this study aims to shed light on this matter.
Methodology:
A descriptive cross-sectional review was conducted. Children who have undergone thoracotomy for non-cardiac pathologies were included in the study. Demographic and clinical data were collected by chart review. Frequencies and percentages were used to describe categorical variables while mean, median, standard deviation and interquartile range were calculated for continuous variables.
Results:
A total of 68 patients were operated on in the study period, out of which 44 (64.7%) were males. The mean ages of the children at the time of diagnosis and procedure were 4.05 ± 3.9 years and 4.14 ± 4.03 years, respectively. The most common indication for thoracotomy was pulmonary hydatid cyst (17; 25%) followed by congenital lobar emphysema (11; 16.2%). Muscle sparing posterolateral thoracotomy was the most common approach in 66 (97.1%) patients. The analgesic medications that were used in the post-operative period were paracetamol, diclofenac, ibuprofen, tramadol and morphine. Combined analgesics were administered in two-thirds of the patients while a single analgesic was used in the rest of the children. No regional blocks were administered post operatively as pediatric size catheters were not available. The morbidity and mortality rates were found to be 11.8% and 8.8%, respectively.
Conclusion:
The most common indication for thoracotomy in this study was pulmonary hydatid cyst. The provision of post-thoracotomy analgesia in our institution is suboptimal as evidenced by no use of regional blocks and poor practice of administering multimodal analgesia. Thoracotomy was associated with fairly high morbidity and mortality.
