Thoracoscopic versus open lobectomy in infants with congenital lung malformations: A multi-institutional propensity score analysis

Midwest Pediatric Surgery Consortium

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: The impact of thoracoscopic surgery on outcomes in children with congenital lung malformations (CLM) remains controversial. The purpose of this study was to determine the effect of operative approach on perioperative outcomes in infants undergoing lobectomy for an asymptomatic CLM. Methods: After IRB approval, a retrospective cohort study was conducted on 506 children with a CLM resected at one of eleven children's hospitals over a seven-year period. Infants undergoing elective lobectomy were identified, and covariates were balanced based on operative approach using propensity scores with full matching. Outcomes were analyzed based on intention to treat with weighted conditional regression. Results: One hundred seventy-five infants met inclusion criteria. There were 67 (38.3%) open, 89 (50.9%) thoracoscopic, and 19 (10.9%) thoracoscopic-converted-to-open lobectomies. Thoracoscopic lobectomy was associated with significantly longer operative times (26 min, 95% CI 6–47 min, p = 0.012) but used less epidural anesthesia (OR 0.02, 95% CI 0.004–0.11, p<0.001) when compared to open lobectomy. There were no significant differences in intraoperative blood loss, postoperative complications, chest tube duration, or length of stay. Conclusions: Thoracoscopy has become the most common operative approach for elective lobectomy in infants with asymptomatic CLMs. The non-inferiority of thoracoscopic lobectomy in postoperative outcomes supports its continued use as an alternative to open lobectomy. Level of Evidence: Treatment study, Level III

Original languageEnglish (US)
Pages (from-to)2148-2156
Number of pages9
JournalJournal of pediatric surgery
Volume56
Issue number12
DOIs
StatePublished - Dec 2021

Keywords

  • Bronchopulmonary sequestration
  • Congenital lobar emphysema
  • Congenital lung malformations
  • Congenital pulmonary airway malformation
  • Propensity score
  • Thoracoscopy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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