title: Fast track pediatric thoracic surgery: Toward day-case surgery?
abstract: OBJECTIVE
  Thoracoscopic lung resection for congenital pulmonary airway malformation (CPAM) is a safe technique for children. Our purpose was to evaluate the feasibility of a fast-track protocol in such cases.
  
  
  METHODS
  From September 2007 to May 2016, 101 patients underwent a thoracoscopic pulmonary resection of which 83 for CPAM (lobectomy, wedge resection or sequestrectomy). We retrospectively reviewed the characteristics of surgical procedure, postoperative management and complications through three time periods (September 2007-December 2009: n=14, January 2010-March 2013: n=30, April 2013-May 2016: n=39) corresponding to management protocols modifications introducing fast-track pathways.
  
  
  RESULTS
  Through the 3 time periods, median postoperative hospital stay decreases (4, 3, 2days successively, P=0.02). In the third time period, 4 patients underwent surgery in day-case surgery. The overall and surgical complication rates, mainly related to air leakage, remain stable through the 3 time periods (14%, P=0.41 and 10%, P=0.52 respectively). Among the 13 patients without postoperative pleural drainage, one required secondary drainage after a partial resection of an emphysema.
  
  
  CONCLUSIONS
  Fast-track protocol for children undergoing uncomplicated thoracic surgery for CPAM seems feasible without extra morbidity. Selected patient undergoing thoracoscopic resection of the lung may benefit from the absence of pleural drainage and can be operated on in day-case surgery.
  
  
  METHODS
  Level III.
authors.affiliation: Department of Pediatric Surgery, Robert Debré Hospital, AP-HP 48 boulevard Sérurier, 75019 Paris, France. Electronic address: pclermidi@gmail.com.
authors.forename: Pauline
authors.initials: P
authors.lastname: Clermidi
authors.affiliation: Department of Pediatric Anesthesiology, Robert Debré Hospital, AP-HP 48 boulevard Sérurier, 75019 Paris, France. Electronic address: myriam.bellon@aphp.fr.
authors.forename: Myriam
authors.initials: M
authors.lastname: Bellon
authors.affiliation: Department of Pediatric Anesthesiology, Robert Debré Hospital, AP-HP 48 boulevard Sérurier, 75019 Paris, France. Electronic address: alia.skhiri@aphp.fr.
authors.forename: Alia
authors.initials: A
authors.lastname: Skhiri
authors.affiliation: Department of Pediatric Surgery, Creteil Intercommunal Hospital, Créteil 40 avenue de Verdun, 94000 Créteil, France. Electronic address: Olivier.Jaby@chicreteil.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Jaby
authors.affiliation: Pediatric Intensive Care Unit, Robert Debré Hospital, AP-HP 48 boulevard Sérurier, 75019 Paris, France. Electronic address: christine.vitoux@aphp.fr.
authors.forename: Christine
authors.initials: C
authors.lastname: Vitoux
authors.affiliation: Department of Anatomopathology, Robert Debré Hospital, AP-HP 48 boulevard Sérurier, 75019 Paris, France. Electronic address: michel.peuchmaur@aphp.fr.
authors.forename: Michel
authors.initials: M
authors.lastname: Peuchmaur
authors.affiliation: Department of Pediatric Surgery, Robert Debré Hospital, AP-HP 48 boulevard Sérurier, 75019 Paris, France. Electronic address: arnaud.bonnard@aphp.fr.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Bonnard
mesh_terms: D000293:Adolescent; D000556:Ambulatory Surgical Procedures; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D011013:Pneumonectomy / Q000379:methods*; D011184:Postoperative Period; D011656:Pulmonary Emphysema / Q000601:surgery; D015619:Respiratory System Abnormalities / Q000601:surgery*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods
keywords: Children; Congenital pulmonary airway malformation; Fast-track surgery; Fasttack protocol; Thoracoscopy