Comparing 30-day outcomes between thoracoscopic and open approaches for resection of pediatric congenital lung malformations: Evidence from NSQIP

• Published in: Journal of pediatric surgery Vol. 50; no. 10; pp. 1716 - 1721
• Main Authors: Kulaylat, Afif N, Engbrecht, Brett W, Hollenbeak, Christopher S, Safford, Shawn D, Cilley, Robert E, Dillon, Peter W
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2015
• Subjects: Adolescent; Child; Child, Preschool; Congenital; Congenital lobar emphysema; CPAM; Female; Humans; Infant; Infant, Newborn; Length of Stay - statistics & numerical data; Lung - abnormalities; Lung - surgery; Lung Diseases - congenital; Lung Diseases - surgery; Male; NSQIP; Pediatrics; Pneumonectomy - methods; Postoperative Complications; Propensity Score; Pulmonary airway malformation; Pulmonary sequestration; Respiratory System Abnormalities - surgery; Surgery; Thoracoscopy; Thoracotomy; Treatment Outcome; ATT; American Society of Anesthesiologist; BPS; CLM; CPAM; CPT; bronchopulmonary sequestration; ASA; congenital lobar emphysema; Pulmonary sequestration; congenital lung malformations; NSQIP; average effect of treatment on the treated; Congenital; American College of Surgeons; surgical site infections; congenital pulmonary airway malformations; SSI; Current Procedural Terminology; National Surgical Quality Improvement Program–Pediatrics; LOS; ACS; hepatopancreatobiliary; NSQIP-P; length of stay; HPB; CLE; Pulmonary airway malformation; Congenital lobar emphysema
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2015.06.007

Abstract Background/Purpose Thoracoscopic surgery has been increasingly utilized in treating pediatric congenital lung malformations (CLM). Comparative studies evaluating 30-day outcomes between thoracoscopic and open resection of CLM are lacking. Methods There were 258 patients identified in pediatric NSQIP with a CLM and pulmonary resection in 2012–2013. Comparisons of patient characteristics and outcomes between surgical approaches were made using standard univariate statistics. In addition, a propensity score match was performed to evaluate outcomes in similar patient cohorts. Results One-hundred twelve patients (43.4%) received thoracoscopic resections and 146 patients (56.6%) received open resections. Patients undergoing open resections were more likely to be less than 5 months of age and have a comorbidity/preoperative condition (47.3% vs. 25.0%, p < 0.001). The extent of resection was a lobectomy in 84.8% of thoracoscopic and 92.5% of open resection patients. Median operative time was similar between both groups (thoracoscopic 172 vs. open 153.5 minutes). On univariate analysis, thoracoscopic resection was associated with decreased postoperative complications (9.8% vs. 25.3%, p = 0.001) and LOS (3 vs. 4 days, p < 0.001). However, after adjusting for similar patient and operative characteristics, no significant differences were encountered between techniques. Conclusions Thoracoscopic and open resection provide comparable 30-day outcomes and safety in the management of congenital lung malformations.