title: Comparing 30-day outcomes between thoracoscopic and open approaches for resection of pediatric congenital lung malformations: Evidence from NSQIP.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, United States.
authors.forename: Afif N
authors.initials: AN
authors.lastname: Kulaylat
authors.affiliation: Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, United States.
authors.forename: Brett W
authors.initials: BW
authors.lastname: Engbrecht
authors.affiliation: Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, United States; Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, United States.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.affiliation: Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, United States.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: Safford
authors.affiliation: Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, United States.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Cilley
authors.affiliation: Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, United States. Electronic address: pdillon1@hmc.psu.edu.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Dillon
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008168:Lung / Q000002:abnormalities* / Q000601:surgery; D008171:Lung Diseases / Q000151:congenital / Q000601:surgery*; D008297:Male; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications; D057216:Propensity Score; D015619:Respiratory System Abnormalities / Q000601:surgery*; D013906:Thoracoscopy; D013908:Thoracotomy; D016896:Treatment Outcome
keywords: CPAM; Congenital; Congenital lobar emphysema; NSQIP; Pulmonary airway malformation; Pulmonary sequestration