Postoperative Intensive Care Unit Stay after Congenital Lung Malformation Resection: Not Always a Necessary Stop

To evaluate criteria associated with intensive care unit (ICU) utilization among children admitted to the ICU after elective congenital lung malformation (CLM) surgery.

A retrospective study of children undergoing elective CLM resection between 2016 and 2023 was conducted. Factors analyzed included demographics and perioperative details. ICU utilization was defined by the occurrence of 1 or more of the following: vasopressor support, continued need for mechanical ventilation due to failure to extubate in the operating room (OR), reintubation, continuous positive airway pressure use, extracorporeal membrane oxygenation support, or continuous monitoring due to concerns about hemodynamic instability.

87 patients were included. The predominant diagnoses were congenital pulmonary airway malformation (34) and intralobar (30) and extralobar (8) sequestrations. Postoperatively, 26.4% (23) were admitted to the floor and 73.6% (64) to the ICU. Only 9% (8) had ICU utilization. Although a prenatal diagnosis and younger age at resection (median: 0.75 years, IQR: 0.60, 1.15) were associated with ICU admission, factors associated with ICU utilization included thoracoscopic converted to open surgery (P = .023), higher estimated blood loss (P = .018), longer total time in the OR (P = .027), and failure to extubate (P = .001). No patients admitted to the floor postoperatively required transfer to the ICU.

Only 9% of patients undergoing elective CLM resection required ICU utilization. Factors contributing to ICU utilization postoperatively included operative approach, estimated blood loss, total time in the OR, and failure to extubate. Customizing patient disposition based on these factors could minimize ICU resource utilization while maintaining patient safety.