Operative Timing for Elective Thoracoscopic Lobectomy for CPAM and Sequestration: A NSQIP-Pediatric Analysis 2017-2021

Background: There is limited literature on optimal timing for elective thoracoscopic lobectomy for congenital pulmonary airway malformations (CPAM) and sequestration. Using NSQIP-P, we aim to assess optimal operative timing for elective thoracoscopic lobectomy for CPAM and sequestration.

Methods: Data from the NSQIP-Pediatric registry was used to evaluate elective thoracoscopic lobectomy patients from 2017 to 2021 diagnosed with congenital pulmonary airway malformation or sequestration. Open lobectomy, ventilator dependent, oxygen dependent, and patients <1 month old were excluded. Clinical characteristics and outcomes were compared for age cohorts (in months): 1-3, 3-6, 6-9, 9-12, 12-24, and 24+.

Results: There were 717 patients identified. Operative time significantly increased with age from 1 to 3 months to the 24+ month cohort (164.9 min-221.7 min, p = 0.014). Rates of conversion to open were 7.4% vs 21.8%, p = 0.181 in these age groups, respectively. Though not statistically significant, 14.8% of patients at 1-3 months had transfusion events reported compared to 6.4% at 3-6 months and 1.3% at 24+ months (p = 0.067). There were no significant differences between age groups for 30-day unplanned readmission, reoperation, non-transfusion complications, all complications, or mortality.

Conclusion: Optimal surgical timing for thoracoscopic lobectomy for CPAM and sequestration is complex. Surgery at younger ages is associated with significantly shorter operative times; however, a greater powered study is needed to further assess the conversion to open rate in patients >3 months and the bleeding/transfusion rate in patients <3 months of age.

Level of evidence (i-v): Level III.