Which Children Benefit From a Surgical Lung Biopsy for Nonmalignant Disease: A Single-Center Study

To improve preoperative decision making, we compare the characteristics and outcomes of children who derived benefit from a surgical lung biopsy obtained for nonmalignant pulmonary disease to those who did not.

A single-institutional retrospective cohort study reviewing electronic medical records of patients <18 y that underwent surgical lung biopsy for nonmalignant pulmonary disease was performed between January 1, 2013 and June 1, 2023. A benefit was defined as a biopsy result that both changed medical management, and the patient survived the hospitalization. Categorical variables were compared via chi-squared or Fisher's exact test and continuous variables via Student's t-test.

One hundred two patients met criteria. Diagnostic yield was 98%. Inpatient mortality was 8.8%. Sixty-two (60.8%) patients benefited from surgical biopsy, whereas 40 (39.2%) did not. Patients who benefited were less likely to require respiratory support preoperatively (11 versus 16, P = 0.013). The diagnoses more frequently found in those who benefitted were fungal pneumonia (15 versus 1, P = 0.003) and pulmonary capillaritis (7 versus 0, P = 0.03). Interstitial fibrosis (3 versus 7, P = 0.04) and alveolar damage (1 versus 5, P = 0.02) were more frequent in those without benefit. Those who did not benefit experienced greater days with a chest tube (2.0 [1.0-2.0] versus 2.0 [1.0-5.5], P = 0.02), greater postoperative transfusions of platelets (4 versus 10, P = 0.008), and fresh frozen plasma (0 versus 3, P = 0.03), and longer length of stay (5.5 versus 14.0 d, P = 0.002).

Patients without respiratory support are more likely to benefit from surgical lung biopsy. Greater chest tube duration, more postoperative transfusions, and longer length of stay are associated with patients who do not benefit.