Kyra M Halbert-Elliott, Nicole J Bertaux, Latoya A Stewart, Terry L Buchmiller, Casey M Calkins, April Carlson, Benjamin D Carr, Darrell L Cass, Joseph T Church, Ashly Chimner, Caitlin J Crosier, S Christopher Derderian, Vincent P Duron, Stephen J Fenton, Anthony Ferrantella, Zoe Flyer, Cecilia Gigena-Heitsman, Brian W Gray, Rakesh R Gurrala, Faraz A Khan, Aimee G Kim, Kezlyn Larsen, Jasmine Lee, Inna N Lobeck, Caroline W Maloney, Jooyoung Park, David Partrick, Deion Pena, Tayana A Jean Pierre, Marissa Ray, Jason O Robertson, Branae Rollins, Beth Rymeski, Marisa E Schwab, Jessica K Sims, Linda M Cherney Stafford, Christopher W Snyder, Raphael C Sun, Lauren R Templeton, Sarah A Tracy, Cortnie Vaughn, Peter T Yu, Irving J Zamora, Shaun M Kunisaki, Congenital Lung Malformation Study Group
In this large multi-institutional study, age at resection was not independently associated with postoperative complication rates. However, the interval between 3 and 9 months of age may represent the clinically preferred window for operative resection given its association with asymptomatic disease. These findings should inform prenatal and preoperative counseling discussions with families.
BACKGROUND: The optimal timing of resection of congenital lung malformations (CLMs) remains controversial. This study evaluated whether postoperative complications and respiratory morbidity differ by age at operative management in children with prenatally diagnosed CLMs METHODS: We performed a retrospective cohort study of patients with a prenatally diagnosed CLM across 19 major children's hospitals in the United States (2016-2023). After excluding neonatal cases, patients undergoing resection were stratified into five groups based on operative age. The primary outcome was 30-day postoperative complications. Secondary outcomes included operative time and length of stay. Statistical comparisons were performed using one-way ANOVA, chi-squared tests, and multivariable logistic regression (p<0.05).
RESULTS: Among 937 patients, there was significant institutional variation in operative age (median range 3-9 months, p<0.0001). Respiratory symptoms were highest in the 1-3-month cohort (24.2%) and lowest between 3-9 months (3.2%, p<0.0001). Prior pneumonia was more frequent after 12 months (3.9%, p<0.0001). Operative time (p=0.80) and hospital length of stay (p=0.47) were similar across cohorts. Although the 1-3-month cohort had the highest observed complication rate (19.4%), overall complication rates did not significantly differ across age cohorts after adjusting for preoperative respiratory symptoms.
CONCLUSION: In this large multi-institutional study, age at resection was not independently associated with postoperative complication rates. However, the interval between 3 and 9 months of age may represent the clinically preferred window for operative resection given its association with asymptomatic disease. These findings should inform prenatal and preoperative counseling discussions with families.