Morbidity related to major lung thoracoscopic resections in children

Area of Science:

• Pediatric Thoracic Surgery
• Surgical Risk Assessment
• Video-Assisted Thoracic Surgery (VATS)

Background:

• Predictors for increased risk in pediatric thoracic surgery include respiratory symptoms and active/previous infections (RAP).
• Video-Assisted Thoracic Surgery (VATS) is increasingly used for major lung resections in children.
• Assessing preoperative predicted risk (PredR) is crucial for managing potential adverse events.

Purpose of the Study:

• To investigate adverse events in pediatric VATS major lung resections considering RAP predictors.
• To compare observed postoperative complication rates (ObsR) with preoperative predicted risk (PredR).
• To analyze the association between RAP predictors and adverse events in pediatric VATS.

Main Methods:

• Retrospective analysis of pediatric VATS major lung resections (2008-2021) from three institutions.
• Utilized a pediatric surgical risk calculator to determine preoperative predicted risk (PredR).
• Classified postoperative complications using the Thoracic Morbidity & Mortality (TM&M) system and conducted subgroup analysis by RAP predictors.

Main Results:

• 37 pediatric patients underwent VATS major lung resections; 56.7% had respiratory symptoms, 38.9% active infection, and 59.5% a history of infections (RAP subpopulations).
• The overall observed complication rate (ObsR) was 45.94%, significantly higher than the mean predicted risk (PredR) of 4.43%.
• ObsR showed a positive association with RAP, particularly 'respiratory symptoms', and the risk calculator underestimated VATS morbidity.

Conclusions:

• The pediatric surgical risk calculator underestimates morbidity in VATS major lung resections.
• Respiratory symptoms and infections (RAP) are associated with increased observed complications in pediatric VATS.
• Further multicentre studies are needed to clarify the correlation between inflammation and surgical adverse events.