Objective: To compare postoperative length of stay and 30-day outcomes between thoracoscopic and open lobectomy performed on a nonemergency basis for congenital pulmonary lesions using a validated national database.
Materials and methods: We identified all nonemergency lobectomies performed on patients with congenital pulmonary lesions in the 2012 National Surgical Quality Improvement Program (NSQIP) Pediatric database and compared demographic, clinical, and 30-day outcome characteristics between patients who underwent an open or thoracoscopic lobectomy. Logistic regression with Firth's penalized likelihood bias-reduction method was used to determine predictive risk factors for a postoperative length of stay (LOS) of >3 days.
Results: Of 101 patients included, 40 (39%) underwent thoracoscopic lobectomy. In comparison with patients undergoing thoracoscopic lobectomy, patients undergoing open lobectomy were significantly more likely to be admitted prior to surgery, be American Society of Anesthesiologists Class ≥ 3, receive oxygen support prior to surgery, and have other congenital anomalies or cardiac risk factors. Both groups had similar total operative times (open versus thoracoscopic, 150 versus 173 minutes; P=.216). Patients undergoing open lobectomy had longer postoperative LOS (4 versus 3 days; P=.001) and more often received an intraoperative or postoperative transfusion (12% versus 0%; P=.003). The procedure type was not an independent risk factor for postoperative LOS >3 days in the multivariable analysis.
Conclusions: Patients undergoing thoracoscopic lobectomy have fewer comorbidities at baseline, receive fewer perioperative transfusions, and have a shorter postoperative LOS. Accrual of additional patients within the NSQIP Pediatric database will allow for further risk-adjusted analyses to control for differences in baseline characteristics between patients undergoing open and thoracoscopic resections.