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

Wagenaar, Amy E.; Tashiro, Jun; Satahoo, Shevonne S.; Sola, Juan E.; Neville, Holly L.; Hogan, Anthony R.; Pérez, Eduardo A.

doi:10.1016/j.jpedsurg.2016.04.020

Cited by 18 publications

(9 citation statements)

References 68 publications

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“…Length of hospital stay was described in 17 NRSs, comparing a total of 3,726 patients. [47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63] Of these eight (41.2%) including 302 patients (8.1%) showed a shorter stay for thoracoscopic lung resections. [48][49][50][51][52][53]61 This finding was confirmed in both MAs (evidence level 3a).…”

Section: Advantages Of Vatsmentioning

confidence: 98%

Video-Assisted Thoracoscopic or Conventional Thoracic Surgery in Infants and Children: Current Evidence

et al. 2020

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Introduction The pros and cons of video-assisted thoracoscopic versus conventional thoracic surgery in infants and children are still under debate. We assessed reported advantages and disadvantages of video-assisted thoracoscopy in pediatric surgical procedures, as well as the evidence level of the available data. Materials and Methods A systematic literature search was performed to identify manuscripts comparing video-assisted thoracoscopic and the respective conventional thoracic approach in classic operative indications of pediatric surgery. Outcome parameters were analyzed and graded for level of evidence (according to the Oxford Centre of Evidence-Based Medicine). Results A total of 48 comparative studies reporting on 12,709 patients, 11 meta-analyses, and one pilot randomized controlled trial including 20 patients were identified. More than 15 different types of advantages for video-assisted thoracoscopic surgery were described, mostly with a level of evidence 3b or 3a. Most frequently video-assisted thoracoscopic surgery was associated with shorter hospital stay, shorter postoperative ventilation, and shorter time to chest drain removal. Mortality rate and severe complications did not differ between thoracoscopic and conventional thoracic pediatric surgery, except for congenital diaphragmatic hernia repair with a lower mortality and higher recurrence rate after thoracoscopic repair. The most frequently reported disadvantage for video-assisted thoracoscopic surgery was longer operative time. Conclusion The available data point toward improved recovery in pediatric video-assisted thoracoscopic surgery despite longer operative times. Further randomized controlled trials are needed to justify the widespread use of video assisted thoracoscopy in pediatric surgery.

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Section: Advantages Of Vatsmentioning

confidence: 98%

Video-Assisted Thoracoscopic or Conventional Thoracic Surgery in Infants and Children: Current Evidence

et al. 2020

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“…Surgical Quality Improvement Program-Pediatric (NSQIP-P), Healthcare Cost and Utilization Project Kid's Inpatient Database, and Nationwide Inpatient Sample, among others [7,40,48]. For example, because the NSQIP-P has yet to contain a lung surgery-specific module, the majority of complications recorded after elective CLM surgery occur infrequently [43,49].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…The incidence of CLMs has increased over time, with more recent studies suggesting an incidence of approximately 1 in 2500 births, likely secondary to widespread prenatal screening as well as improvements in ultrasound image quality [4][5][6]. From 1997 to 2009, the number of operative CLM cases increased almost three-fold [7]. Although the etiology of CLMs is unclear, the inciting event may be related to transient bronchial obstruction during the canalicular phase of lung morphogenesis [1,8].…”

Section: Introductionmentioning

confidence: 99%

Development of a multi-institutional registry for children with operative congenital lung malformations

Kunisaki

Saito

Fallat

et al. 2020

Journal of Pediatric Surgery

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Introduction: The purpose of this study was to develop a multi-institutional registry to characterize the demographics, management, and outcomes of a contemporary cohort of children undergoing congenital lung malformation (CLM) resection. Methods: After central reliance IRB approval, a web-based, secure database was created to capture retrospective cohort data on pathologically-confirmed CLMs performed between 2009-2015 within a multi-institutional research collaborative. Results: Eleven children's hospitals contributed 506 patients. Among 344 prenatally diagnosed lesions, the congenital pulmonary airway malformation volume ratio was measured in 49.1%, and fetal MRI was performed in 34.3%. One hundred thirty-four (26.7%) children had respiratory symptoms at birth. Fifty-eight (11.6%) underwent neonatal resection, 322 (64.1%) had surgery at 1-12 months, and 122 (24.3%) had operations after 12 mos. The median age at resection was 6.7 months (interquartile range, 3.6-11.4). Among 230 elective lobectomies performed in asymptomatic patients, thoracoscopy was successfully utilized in 102 (44.3%), but there was substantial variation across centers. The most common lesions were congenital pulmonary airway malformation (n=234, 47.3%) and intralobar bronchopulmonary sequestration (n=106, 21.4%). Conclusion: This multicenter cohort study on operative CLMs highlights marked disease heterogeneity and substantial practice variation in preoperative evaluation and operative management. Future registry studies are planned to help establish evidencebased guidelines to optimize the care of these patients.

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“…[ 126 127 128 129 ] Some studies report lower incidences of thoracic and spinal deformities,[ 130 ] potential improvements in long term-pulmonary function,[ 9 ] and no increases in complications in patients undergoing lobectomies via thoracoscopy. [ 121 131 132 133 ] However, during thoracoscopy with utilization of an artificial pneumothorax, CO 2 insufflation leads to a high rate of systemic CO 2 absorption. [ 134 135 ] In infants undergoing repair of congenital diaphragmatic hernia (CDH) and TEF via thoracoscopy, this is associated with significant intraoperative hypercapnia and acidosis, leading some groups to question its safety.…”

Section: Intraoperative Anesthetic Care For Specific Diagnostic and Surgical Proceduresmentioning

confidence: 99%

“…Patients with these lesions frequently present in infancy for surgical lobectomy, although some lesions are amenable to segmentectomy or wedge resection. [ 133 140 141 142 ] A unique consideration in this patient population is the variable response of the individual lesions to positive pressure ventilation. Any lesion with an abnormal connection to the tracheobronchial tree, in particular CLE and some cases of CPAM, is at risk of progressive distention with ventilation due to a ball-valve effect within the diseased area, with deleterious effects on both the surrounding lung parenchyma and the major structures of the thorax necessitates.…”

Section: Intraoperative Anesthetic Care For Specific Lesionsmentioning

confidence: 99%

Anesthesia for thoracic surgery in infants and children

Murray-Torres

Winch

Naguib

et al. 2021

Saudi Journal of Anaesthesia

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The management of infants and children presenting for thoracic surgery poses a variety of challenges for anesthesiologists. A thorough understanding of the implications of developmental changes in cardiopulmonary anatomy and physiology, associated comorbid conditions, and the proposed surgical intervention is essential in order to provide safe and effective clinical care. This narrative review discusses the perioperative anesthetic management of pediatric patients undergoing noncardiac thoracic surgery, beginning with the preoperative assessment. The considerations for the implementation and management of one-lung ventilation (OLV) will be reviewed, and as will the anesthetic implications of different surgical procedures including bronchoscopy, mediastinoscopy, thoracotomy, and thoracoscopy. We will also discuss pediatric-specific disease processes presenting in neonates, infants, and children, with an emphasis on those with unique impact on anesthetic management.

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

Cited by 18 publications

References 68 publications

Video-Assisted Thoracoscopic or Conventional Thoracic Surgery in Infants and Children: Current Evidence

Video-Assisted Thoracoscopic or Conventional Thoracic Surgery in Infants and Children: Current Evidence

Development of a multi-institutional registry for children with operative congenital lung malformations

Anesthesia for thoracic surgery in infants and children

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