Resection of pediatric lung malformations: National trends in resource utilization & outcomes

J Pediatr Surg. 2016 Sep;51(9):1414-20. doi: 10.1016/j.jpedsurg.2016.04.020. Epub 2016 May 17.

Abstract

Purpose: We sought to determine factors influencing survival and resource utilization in patients undergoing surgical resection of congenital lung malformations (CLM). Additionally, we used propensity score-matched analysis (PSMA) to compare these outcomes for thoracoscopic versus open surgical approaches.

Methods: Kids' Inpatient Database (1997-2009) was used to identify congenital pulmonary airway malformation (CPAM) and pulmonary sequestration (PS) patients undergoing resection. Open and thoracoscopic CPAM resections were compared using PSMA.

Results: 1547 cases comprised the cohort. In-hospital survival was 97%. Mortality was higher in small vs. large hospitals, p<0.005. Survival, pneumothorax (PTX), and thoracoscopic procedure rates were higher, while transfusion rates and length of stay (LOS) were lower, in children ≥3 vs. <3months (p<0.001). Multivariate analysis demonstrated longer LOS for older patients and Medicaid patients (all p<0.005). Total charges (TC) were higher for Western U.S., older children, and Medicaid patients (p<0.02). PSMA for thoracoscopy vs. thoracotomy in CPAM patients showed no difference in outcomes.

Conclusion: CLM resections have high associated survival. Children <3months of age had higher rates of thoracotomy, transfusion, and mortality. Socioeconomic status, age, and region were independent indicators for resource utilization. Extent of resection was an independent prognostic indicator for in-hospital survival. On PSMA, thoracoscopic resection does not affect outcomes.

Keywords: Bronchopulmonary sequestration; Congenital pulmonary airway malformation; Health resources; Outcome assessment; Thoracoscopy; Thoracotomy.

MeSH terms

  • Adolescent
  • Age Factors
  • Child
  • Child, Preschool
  • Databases, Factual
  • Female
  • Hospital Mortality*
  • Humans
  • Infant
  • Infant, Newborn
  • Length of Stay / economics
  • Length of Stay / statistics & numerical data
  • Lung / abnormalities*
  • Lung / surgery
  • Male
  • Multivariate Analysis
  • Pneumonectomy* / economics
  • Pneumonectomy* / methods
  • Pneumonectomy* / mortality
  • Propensity Score
  • Respiratory System Abnormalities / economics
  • Respiratory System Abnormalities / mortality
  • Respiratory System Abnormalities / surgery*
  • Retrospective Studies
  • Thoracoscopy* / economics
  • Thoracoscopy* / mortality
  • Thoracotomy* / economics
  • Thoracotomy* / mortality
  • Treatment Outcome
  • United States
  • Young Adult