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The changing spectrum of pulmonary operations in infants and children
Insights
Pediatric pulmonary resections have shifted from treating infections like tuberculosis to addressing congenital anomalies, with a decrease in patient age and a rise in infant surgeries. Overall procedure numbers remain stable.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Pulmonary Medicine
Background:
- Pulmonary resections in children were historically driven by infectious diseases like tuberculosis and bronchiectasis.
- A significant shift in indications for pediatric lung surgery has occurred over several decades.
Purpose of the Study:
- To analyze trends in pediatric pulmonary resections over a 37-year period (1943-1980).
- To identify changes in the spectrum of diseases requiring surgery and associated outcomes.
Main Methods:
- Retrospective analysis of 86 major pulmonary resections in 73 pediatric patients.
- Data collected over a 37-year period, examining indications, procedures, mortality, and complications.
Main Results:
- Indications shifted from infections to congenital pulmonary anomalies, which now dominate.
- The age of patients undergoing surgery has decreased, with infants comprising nearly half of recent cases.
- Operative mortality was 4.4%, and disease-related late mortality was 6.2%; complications occurred in 21.9% of operations.
Conclusions:
- Pediatric pulmonary surgery has evolved, with congenital conditions replacing infections as primary indications.
- The trend towards earlier intervention in infants highlights advancements and changing disease patterns.
- Despite declining infectious disease rates, the overall volume of pediatric pulmonary operations has remained consistent.
Abstract:
During the 37 year period between 1943 and 1980, 68 pediatric patients underwent 86 major pulmonary resections during 73 separate operations. The surgical procedures included lobectomy (55), segmentectomy (25), pneumonectomy (three), and cyst excision (three). The 73 operations were performed for nontuberculous infection, congenital malformation, tuberculosis, tumor, obstructive lung disease, cardiac-related problems, immunologic disease, and trauma in decreasing order of frequency. The operative mortality was 4.4%; the disease-relate late mortality was 6.2%, due to either chronic respiratory failure or metastatic disease. Complications occurred in 21.9% of the operations. Only one death occurred during the last two decades, but the morbidity rate remained constant through all decades. Analysis by decade showed a striking change in the spectrum of pediatric pulmonary operations over the 37 year study period. Three major trends were identified: (1) Bronchiectasis and tuberculosis, once the major indications for pulmonary resection, have, from a surgical standpoint, virtually disappeared. (2) Congenital pulmonary anomalies now account for the majority of major pediatric pulmonary resections. As a consequence, the patient age at operation has steadily decreased, and pulmonary resections in infants (under 1 year of age) make up almost half of the surgical resections currently being done. (3) Despite the marked decline in the number of operations performed for infectious pulmonary disease, the total number of pulmonary operations in the pediatric age group has not decreased.