Surgical management of bronchopulmonary malformations

Amy E. Wagenaar, Jun Tashiro, Alicia Hirzel, Luis I. Rodriguez, Eduardo Perez, Anthony Richard Hogan, Holly Neville, Juan E Sola

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background Bronchopulmonary malformations (BPM) are rare conditions, which typically arise below the carina and can result in significant morbidity (infection and/or hemorrhage) and mortality (respiratory failure). Materials and methods All children with BPM surgically treated from 2001-2014 at a tertiary care children's hospital were identified. Patient demographics, surgical indications, procedure type, estimated blood loss, pathology, perioperative complications, length of stay, and outcomes were analyzed. Results A total of 41 BPM patients underwent surgery with 98% overall survival (one abdominal BPM expired) but 100% for thoracic lesions. Resections were performed thoracoscopically (37%), thoracoscopy converted to open (22%), and via thoracotomy (37%). Poor visualization (67%) or inability to tolerate single lung ventilation (33%) led to conversions. No conversions resulted from hemorrhage or received blood transfusions. Patients with prenatally diagnosed BPM were more likely to undergo thoracoscopic surgery (odds ratio [OR], 18.2) versus nonprenatally diagnosed, P = 0.002. Open/converted patients had longer chest tube days (6.2) versus thoracoscopic (2.9), P = 0.048. Additionally, respiratory distress was a more common indication in patients aged <4 mo (OR, 28.0) versus ≥4 mo and <6 kg (OR, 40.5) versus ≥6 kg, P < 0.001. Open resections were more common in patients aged <4 mo (OR, 26.3) versus ≥4 mo, P = 0.002. Operative time was shorter and estimated blood loss (mL/kg) was greater for <6 versus ≥6 kg, P < 0.05. Conclusions BPM resections have high overall survival. Chest tube days are shorter among thoracoscopic patients, but conversion to thoracotomy can avoid hemorrhage and need for transfusion. Size and respiratory distress limit use of thoracoscopy in young infants with BPM.

Original languageEnglish (US)
Pages (from-to)406-412
Number of pages7
JournalJournal of Surgical Research
Volume198
Issue number2
DOIs
StatePublished - Oct 1 2015

Fingerprint

Thoracoscopy
Odds Ratio
Chest Tubes
Thoracotomy
Hemorrhage
One-Lung Ventilation
Survival
Tertiary Healthcare
Operative Time
Blood Transfusion
Respiratory Insufficiency
Length of Stay
Thorax
Demography
Pathology
Morbidity
Mortality
Infection

Keywords

  • Bronchopulmonary sequestration
  • Congenital
  • Cystic adenomatoid malformation of lung
  • Outcomes research
  • Respiratory system abnormalities

ASJC Scopus subject areas

  • Surgery

Cite this

Surgical management of bronchopulmonary malformations. / Wagenaar, Amy E.; Tashiro, Jun; Hirzel, Alicia; Rodriguez, Luis I.; Perez, Eduardo; Hogan, Anthony Richard; Neville, Holly; Sola, Juan E.

In: Journal of Surgical Research, Vol. 198, No. 2, 01.10.2015, p. 406-412.

Research output: Contribution to journalArticle

Wagenaar, Amy E. ; Tashiro, Jun ; Hirzel, Alicia ; Rodriguez, Luis I. ; Perez, Eduardo ; Hogan, Anthony Richard ; Neville, Holly ; Sola, Juan E. / Surgical management of bronchopulmonary malformations. In: Journal of Surgical Research. 2015 ; Vol. 198, No. 2. pp. 406-412.
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abstract = "Background Bronchopulmonary malformations (BPM) are rare conditions, which typically arise below the carina and can result in significant morbidity (infection and/or hemorrhage) and mortality (respiratory failure). Materials and methods All children with BPM surgically treated from 2001-2014 at a tertiary care children's hospital were identified. Patient demographics, surgical indications, procedure type, estimated blood loss, pathology, perioperative complications, length of stay, and outcomes were analyzed. Results A total of 41 BPM patients underwent surgery with 98{\%} overall survival (one abdominal BPM expired) but 100{\%} for thoracic lesions. Resections were performed thoracoscopically (37{\%}), thoracoscopy converted to open (22{\%}), and via thoracotomy (37{\%}). Poor visualization (67{\%}) or inability to tolerate single lung ventilation (33{\%}) led to conversions. No conversions resulted from hemorrhage or received blood transfusions. Patients with prenatally diagnosed BPM were more likely to undergo thoracoscopic surgery (odds ratio [OR], 18.2) versus nonprenatally diagnosed, P = 0.002. Open/converted patients had longer chest tube days (6.2) versus thoracoscopic (2.9), P = 0.048. Additionally, respiratory distress was a more common indication in patients aged <4 mo (OR, 28.0) versus ≥4 mo and <6 kg (OR, 40.5) versus ≥6 kg, P < 0.001. Open resections were more common in patients aged <4 mo (OR, 26.3) versus ≥4 mo, P = 0.002. Operative time was shorter and estimated blood loss (mL/kg) was greater for <6 versus ≥6 kg, P < 0.05. Conclusions BPM resections have high overall survival. Chest tube days are shorter among thoracoscopic patients, but conversion to thoracotomy can avoid hemorrhage and need for transfusion. Size and respiratory distress limit use of thoracoscopy in young infants with BPM.",
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T1 - Surgical management of bronchopulmonary malformations

AU - Wagenaar, Amy E.

AU - Tashiro, Jun

AU - Hirzel, Alicia

AU - Rodriguez, Luis I.

AU - Perez, Eduardo

AU - Hogan, Anthony Richard

AU - Neville, Holly

AU - Sola, Juan E

PY - 2015/10/1

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N2 - Background Bronchopulmonary malformations (BPM) are rare conditions, which typically arise below the carina and can result in significant morbidity (infection and/or hemorrhage) and mortality (respiratory failure). Materials and methods All children with BPM surgically treated from 2001-2014 at a tertiary care children's hospital were identified. Patient demographics, surgical indications, procedure type, estimated blood loss, pathology, perioperative complications, length of stay, and outcomes were analyzed. Results A total of 41 BPM patients underwent surgery with 98% overall survival (one abdominal BPM expired) but 100% for thoracic lesions. Resections were performed thoracoscopically (37%), thoracoscopy converted to open (22%), and via thoracotomy (37%). Poor visualization (67%) or inability to tolerate single lung ventilation (33%) led to conversions. No conversions resulted from hemorrhage or received blood transfusions. Patients with prenatally diagnosed BPM were more likely to undergo thoracoscopic surgery (odds ratio [OR], 18.2) versus nonprenatally diagnosed, P = 0.002. Open/converted patients had longer chest tube days (6.2) versus thoracoscopic (2.9), P = 0.048. Additionally, respiratory distress was a more common indication in patients aged <4 mo (OR, 28.0) versus ≥4 mo and <6 kg (OR, 40.5) versus ≥6 kg, P < 0.001. Open resections were more common in patients aged <4 mo (OR, 26.3) versus ≥4 mo, P = 0.002. Operative time was shorter and estimated blood loss (mL/kg) was greater for <6 versus ≥6 kg, P < 0.05. Conclusions BPM resections have high overall survival. Chest tube days are shorter among thoracoscopic patients, but conversion to thoracotomy can avoid hemorrhage and need for transfusion. Size and respiratory distress limit use of thoracoscopy in young infants with BPM.

AB - Background Bronchopulmonary malformations (BPM) are rare conditions, which typically arise below the carina and can result in significant morbidity (infection and/or hemorrhage) and mortality (respiratory failure). Materials and methods All children with BPM surgically treated from 2001-2014 at a tertiary care children's hospital were identified. Patient demographics, surgical indications, procedure type, estimated blood loss, pathology, perioperative complications, length of stay, and outcomes were analyzed. Results A total of 41 BPM patients underwent surgery with 98% overall survival (one abdominal BPM expired) but 100% for thoracic lesions. Resections were performed thoracoscopically (37%), thoracoscopy converted to open (22%), and via thoracotomy (37%). Poor visualization (67%) or inability to tolerate single lung ventilation (33%) led to conversions. No conversions resulted from hemorrhage or received blood transfusions. Patients with prenatally diagnosed BPM were more likely to undergo thoracoscopic surgery (odds ratio [OR], 18.2) versus nonprenatally diagnosed, P = 0.002. Open/converted patients had longer chest tube days (6.2) versus thoracoscopic (2.9), P = 0.048. Additionally, respiratory distress was a more common indication in patients aged <4 mo (OR, 28.0) versus ≥4 mo and <6 kg (OR, 40.5) versus ≥6 kg, P < 0.001. Open resections were more common in patients aged <4 mo (OR, 26.3) versus ≥4 mo, P = 0.002. Operative time was shorter and estimated blood loss (mL/kg) was greater for <6 versus ≥6 kg, P < 0.05. Conclusions BPM resections have high overall survival. Chest tube days are shorter among thoracoscopic patients, but conversion to thoracotomy can avoid hemorrhage and need for transfusion. Size and respiratory distress limit use of thoracoscopy in young infants with BPM.

KW - Bronchopulmonary sequestration

KW - Congenital

KW - Cystic adenomatoid malformation of lung

KW - Outcomes research

KW - Respiratory system abnormalities

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