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Age-related outcomes after pediatric branchial cleft cyst excision via NSQIP-P
Maya Raghavan1, Michele M Carr2
1Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14209, USA.
Insights
Branchial cleft cyst excision is safe in children, with no increased complications in younger age groups. Operative time increases with age, but overall outcomes remain favorable for pediatric patients.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Surgical Outcomes Research
Background:
- Branchial cleft cysts are congenital anomalies requiring surgical excision.
- Excision in very young children is sometimes delayed due to perceived risks.
- Understanding age-related outcomes is crucial for surgical decision-making.
Purpose of the Study:
- To evaluate if outcomes and complication rates differ among pediatric age groups undergoing branchial cleft cyst excision.
- To identify age-specific risk factors and complications associated with this procedure.
Main Methods:
- Retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Pediatric (ACS NSQIP-P) database.
- Inclusion of 2267 pediatric patients who underwent branchial cleft cyst excision (CPT code 42,815) between 2016 and 2020.
- Analysis of patient demographics, comorbidities, pre-operative risk factors, operative details, and post-operative complications.
Main Results:
- A total of 2267 patients were analyzed, with a median age of 3.9 years.
- The most common pre-operative risk factors included prematurity, developmental delay, and congenital malformations.
- Overall complication rate was low (3%), with surgical site infections being the most frequent. No significant correlation was found between patient age and complication incidence.
- Operative time and duration of anesthesia increased significantly with patient age (p < .001).
Conclusions:
- Branchial cleft cyst excision is a safe procedure in the pediatric population across various age groups.
- The incidence of complications is low, even in very young children.
- Age is not a significant factor in predicting complications, though operative time increases with age.
Objective:
Branchial cleft cysts present at varying ages; sometimes excision is delayed because of concern about operating in small children. Our goal was to determine if outcomes and complications differed among pediatric age groups.
Study Design:
Retrospective, cross-sectional.
Setting:
American College of Surgeons' National Surgical Quality Improvement Pediatric database.
Methods:
Patients who underwent a branchial cleft cyst excision between 2016 and 2020 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Pediatric database. Patients with CPT code 42,815: 'excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into the pharynx' as their primary procedure were included. Variables of interest included patient demographics, comorbidities, pre-operative risk factors and complications.
Results:
2267 patients with median age of 3.9 (IQR: 7.4, range: 0.04-17.9) years were included. The most common pre-operative risk factors were 149 (7 %) patients with prematurity, 136 (6 %) with developmental delay, 135 (6 %) with congenital malformation, and 128 (6 %) with open wound or wound infection. 68 (3 %) patients experienced at least one post-operative complication, with 73 post-operative complications documented in total. Surgical site infections were the most common complications with 49 (67.1 %) superficial infections, 11 (15.1 %) deep infections, and 4 (5.5 %) organ/space infections. Surgical site infections were the most common reason for related readmission. Duration of anesthesia and operative time increased significantly as patient age increased (p < .001 for both). There was no significant correlation between age and complication incidence.
Conclusion:
Branchial cleft cyst excision is a relatively safe operation with a low complication rate, even in young pediatric populations.
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