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

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• 作者：Amy E. Wagenaar ; Jun Tashiro ; Shevonne S. Satahoo ; Juan E. Sola ; Holly L. Neville ; Anthony R. Hogan ; Eduardo A. Perez ; ^{EPerez3@med.miami.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：CLM ; congenital lung malformations ; PSMA ; propensity score-matched analysis ; CPAM ; congenital pulmonary airway malformation ; PS ; pulmonary sequestration ; PTX ; pneumothorax ; LOS ; length of stay ; TC ; total charges ; KID ; Kids' Inpatient Database ; HCUP ; Healthcare Cost and Utilization Project ; AHRQ ; Agency for Healthcare Research and Quality ; ICD-9-CM ; International Classification of Diseases ; Ninth Revision ; Clinical Modification ; USD ; United States dollars ; MIQ ; median household income by zip code
• 刊名：Journal of Pediatric Surgery
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：51
• 期：9
• 页码：1414-1420
• 全文大小：400 K

文摘

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. < 3 months (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.

Conclusion

CLM resections have high associated survival. Children < 3 months 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.