J. Tashiro1, J. E. Sola1, H. L. Neville1, A. R. Hogan1, E. A. Perez1 1University Of Miami,Division Of Pediatric Surgery, DeWitt Daughtry Family Department Of Surgery,Miami, FL, USA
Introduction: Congenital Cystic Adenomatoid Malformation (CCAM) and Pulmonary Hypoplasia/Sequestration (H/S) are rare lung malformations.
Methods: Kids’ Inpatient Database (1997-2009) was used to identify all CCAM and H/S patients undergoing resection. Cases were analyzed using standard and multivariate regression methods. Open and thoracoscopic CCAM resections were compared using propensity score-matched analysis (PSMA).
Results: Overall, 1,548 cases comprised the cohort (CCAM 56%, H/S 40%, both 4%). Survival was 97%. Average length of stay (LOS) decreased, while total charges (TC) increased during the study period (p<0.001). Mean age at admission was 2.2 years. CCAM had 1.4% mortality with self-pay, lowest income quartile patients, and small bedsize hospitals having higher mortality (p<0.05). H/S had 4.6% mortality with rural hospitals having higher mortality vs urban teaching hospitals, p=0.027. When pooled, survival, pneumothorax (PTX), and thoracoscopic procedure rates were higher in children having resection at ≥3 vs <3 months of age (p<0.001). Transfusion rates and LOS however, were lower in patients ≥3 vs <3 months of age (p<0.001), whereas lobectomy rates were unchanged. Analysis for ≥6 vs <6 months of age produced similar results. On multivariate analysis of the cohort, LOS was shorter in children’s general hospitals (CGH) and non-children’s hospitals (NCH) vs children’s units in general hospitals (CUGH), p<0.05. LOS was longer for older patients, those with Medicaid, and those admitted in Midwestern and Southern U.S. (all p<0.001) and for CCAM (p=0.006). TC were lower for the 2nd/3rd income quartile, but higher for Western U.S. (p<0.004) and Medicaid patients (p=0.015). Small and medium bedsize hospitals had higher mortality vs large hospitals, p<0.005. NCH and CGH had higher survival vs CUGH, p<0.04. Segmentectomy and lobectomy patients had improved survival (p<0.02), while pneumonectomy patients had higher mortality (p<0.025). PSMA for thoracoscopy vs thoracotomy in CCAM patients showed no difference in LOS, disposition, TC, resection type, or transfusion / PTX rates.
Conclusion: Surgery for CCAM and H/S has high associated survival. When analyzed by age at resection, children <3 months of age had higher mortality, thoracotomy, and transfusion rates vs those ≥3 months, though PTX were more common ≥3 months. Socioeconomic status, age, diagnosis, hospital type, and region were independent indicators for resource utilization. Hospital bed size, type, and extent of resection were independent prognostic indicators for survival. On PSMA thoracoscopic resection does not affect resource utilization, disposition, or transfusion / PTX rates.
