Hospital Volume and Postoperative Outcomes after Elective Lung Resection in Infants with Congenital Lung Malformations

Abstract

INTRODUCTION: The relationship between hospital volume and patient outcomes after pediatric lung resection remains unknown. This study evaluated the association between hospital volume and postoperative outcomes in infants undergoing elective lung resection for congenital lung malformations (CLM). METHODS: After IRB approval, infants >30 days of age who underwent elective CLM resection were identified in the Pediatric Health Information System database (2016 to 2020). Those with previous symptomatic disease were excluded. Annual lung resection tertiles were used to classify hospitals into low (1 to 7 cases), medium (8 to 11 cases), or high (>11 cases) volume centers. Primary outcomes were hospital length of stay (LOS) and postoperative complications. Linear or Poisson multivariable regressions were performed. RESULTS: There were 1,420 infants from 48 hospitals. CLMs included congenital pulmonary airway malformations (n = 623, 43.9%) and bronchopulmonary sequestrations (n = 364, 25.6%). The mean annual cases at low-, medium-, and high-volume hospitals were 4.6 ± 1.6, 8.9 ± 1.2, and 36.4 ± 23.6, respectively. The median LOS was 2 days (interquartile range 2 to 3), and there were no differences based on center volume (p = 0.139). Overall postoperative complications were significantly increased at low-volume centers (31.1%) compared with medium-volume (16%) and high-volume (25%) centers (p < 0.001; Table 1). Respiratory complications were significantly increased in low-volume centers (28.8%) compared with medium-volume (14%) and high-volume (23%) centers (p < 0.001). Adjusted odd ratios showed a 51% reduction in overall complications (95% CI 0.37 to 0.65, p < 0.001) at medium/high-volume centers. Table 1. - Patient Outcomes by Center Volume Variable Low (n =89 patients) Medium (n = 534 patients) High (n = 497 patients) p Value Operative approach Thoracoscopic, n (%) 295 (75.8) 403 (75.5) 248 (49.9) <0.001 Open, n (%) 121 (31.1) 83 (15.5) 124 (24.9) <0.001 Respiratory complications, n (%) 112 (28.8) 73 (13.7) 112 (22.5) <0.001 Postoperative ventilation, n (%) 25 (6.4) 32 (6.0) 15 (3.0) 0.034 Length of stay (d), median (IQR) 2.00 (2–4) 2.00 (2–3) 2.00 (2–3) 0.139 Mortality, n (%) 1 (0.3) 1 (0.2) 0 (0) 0.7366 30-day readmission, n (%) 22 (5.7) 16 (3.0) 14 (2.8) 0.062 CONCLUSION: For elective infant lung resections, these data suggest that low-volume hospitals are associated with increased postoperative complications. Further study of CLM outcomes, including the role of surgeon-specific volume, is warranted.