title: Thoracoscopic Vs open resection of congenital cystic lung disease- utilization and outcomes in 1120 children in the United States.
abstract: OBJECTIVE
  To determine if utilization of thoracoscopic resection of congenital cystic lung disease (CLD) is increasing and if this approach is associated with improved outcomes using a large national sample.
  
  
  METHODS
  Children ≤20years old who underwent resection of a congenital cystic adenomatoid malformation, bronchopulmonary sequestration, or bronchogenic cyst were identified from the Healthcare Cost and Utilization Project Kids' Inpatient Database (2009, 2012) and Nationwide Inpatient Sample (2008, 2010-2011). Patient characteristics and outcomes were compared between thoracoscopic and open approaches using univariate and multivariable analyses stratified by magnitude of resection.
  
  
  RESULTS
  Thoracoscopic resection was used in 39.4% of 1120 children who underwent resection of CLD. Utilization of the thoracoscopic approach increased from 32.2% in 2008 to 48.2% in 2012. Use of thoracoscopy was lower in lobectomy than segmental resection (32.5 vs 48.4%, p<.001). Newborns, those with comorbid congenital conditions, and those with respiratory infections also had lower rates of thoracoscopy. After stratifying by magnitude of resection and adjusting for patient complexity, complication rates and postoperative length of stay were similar between thoracoscopic and open approaches.
  
  
  CONCLUSIONS
  Utilization of thoracoscopic resection for CLD in the United States is increasing with time. After adjusting for patient complexity, there is no difference in postoperative length of stay or complications between thoracoscopic and open lobectomy and sub-lobar resection.
authors.affiliation: Mayo Clinic Rochester, Rochester, MN, USA.
authors.forename: Stephanie F
authors.initials: SF
authors.lastname: Polites
authors.affiliation: Mayo Clinic Rochester, Rochester, MN, USA.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
authors.affiliation: Mayo Clinic Rochester, Rochester, MN, USA.
authors.forename: Abdalla E
authors.initials: AE
authors.lastname: Zarroug
authors.affiliation: Mayo Clinic Rochester, Rochester, MN, USA.
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Thomsen
authors.affiliation: Mayo Clinic Rochester, Rochester, MN, USA. Electronic address: potter.d@mayo.edu.
authors.forename: Donald D
authors.initials: DD
authors.lastname: Potter
mesh_terms: D000704:Analysis of Variance; D001994:Bronchogenic Cyst / Q000000981:diagnostic imaging / Q000601:surgery*; D001998:Bronchopulmonary Sequestration / Q000000981:diagnostic imaging / Q000601:surgery*; D002675:Child, Preschool; D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications; D011184:Postoperative Period; D011656:Pulmonary Emphysema / Q000151:congenital* / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000706:statistics & numerical data* / Q000639:trends; D016896:Treatment Outcome; D014481:United States
keywords: Congenital cystic lung disease; Pediatric thoracoscopic lung resection