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


CONCLUSIONS
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.
Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Amy E
AE
Wagenaar
Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Jun
J
Tashiro
Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Shevonne S
SS
Satahoo
Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Juan E
JE
Sola
Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Holly L
HL
Neville
Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Anthony R
AR
Hogan
Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA. Electronic address: EPerez3@med.miami.edu.
Eduardo A
EA
Perez
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008168:Lung / Q000002:abnormalities* / Q000601:surgery; D008297:Male; D015999:Multivariate Analysis; D011013:Pneumonectomy / Q000191:economics / Q000379:methods / Q000401:mortality; D057216:Propensity Score; D015619:Respiratory System Abnormalities / Q000191:economics / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000191:economics / Q000401:mortality; D013908:Thoracotomy / Q000191:economics / Q000401:mortality; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
Bronchopulmonary sequestration; Congenital pulmonary airway malformation; Health resources; Outcome assessment; Thoracoscopy; Thoracotomy