Factors to consider when performing surgical lung biopsies in pediatric patients
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Key takeaways:
- Four characteristics significantly raised a pediatric patient’s likelihood for death within 30 days after surgical lung biopsy.
- In 2000 to 2004, the mortality rate was 6.6%, whereas in 2015 to 2019, it was 3%.
Following a surgical lung biopsy, pediatric patients faced greater odds for death within 30 days of their procedure if it was open vs. a video-assisted thoracoscopic surgery and if it was nonelective vs. elective, according to a study.
The results were published in Annals of the American Thoracic Society.
“This research study uses population-based data to determine the 30-day mortality post-pediatric surgical lung biopsy and identifies key risk factors for worse outcomes,” Wallace B. Wee, MD, staff pediatric respirologist at The Hospital for Sick Children in Canada, told Healio. “The study’s findings provide clinicians with additional information for counselling patients and their families about surgical lung biopsies, ultimately helping with the informed decision-making process.”
Using population-based health administrative data housed at ICES from 2000 to 2019, Wee and colleagues evaluated 1,474 pediatric patients (48.9% aged 15 to 17 years; 66.6% boys) from Ontario, Canada, who underwent their first surgical lung biopsy for nonmalignant lung disease, to determine the mortality rate 30 days after a surgical lung biopsy and what patient factors heightened the odds for mortality.
The year group with the most biopsies was 2010 to 2014 with 29.2% of patients, followed by 2005 to 2009 with 25.6% of patients, 2015 to 2019 with 24.5% of patients and 2000 to 2004 with 20.7% of patients.
A greater proportion of patients (55.4%) had a nonelective procedure (n = 817; 49.8% aged 15 to 17 years; 66.3% boys) vs. an elective procedure (44.6%; n = 657; 47.6% aged 15 to 17 years; 67% boys), and researchers observed a similar proportion of patients who received video-assisted thoracoscopic surgery in the nonelective (59.8%) and elective (58.1%) groups.
In the earlier years of the assessed time period (2000 to 2004), the mortality rate was 6.6%, whereas in the more recent years (2015 to 2019), the mortality rate was lower at 3%. Additionally, between 2002 to 2004 and 2015 to 2019, the number of patients receiving video-assisted thoracoscopic surgery went up (39.9% vs. 65.4%).
“We hypothesize that these trends may be attributed in part to a growing recognition of [childhood] ILD with an increase in publications beginning in 2004 and improvements in surgical technique,” Wee and colleagues wrote. “In addition, genetic testing in infants with [childhood] ILD may have led to an avoidance of lung biopsies in the most vulnerable patients.”
Within the study population, complete data were available for 1,342 patients (83% aged > 12 months; 67% boys; 55.4% nonelective) out of 1,474 patients due to surgical approach not being collected before 2002.
Researchers found that 5.1% of patients died 30 days after their lung biopsy. Notably, when looking at just elective cases, the mortality rate was less than 1%.
More patients in the nonelective vs. elective group had pneumonia (16.3% vs. 5.7%) and went to the ICU (8.5% vs. 4.7%) following surgical lung biopsy.
In terms of risk factors, four characteristics significantly raised a patient’s likelihood for mortality within 30 days after the biopsy:
- open surgical lung biopsy vs. video-assisted thoracoscopic surgery (OR = 13.13; 95% CI, 3.76-45.87;);
- nonelective vs. elective procedure (OR = 11.74; 95% CI, 3.51-39.27);
- age less than 3 months (OR = 6.04; 95% CI, 2.4-15.22); and
- higher Johns Hopkins Adjusted Clinical Group System (ACG) comorbidity score (OR = 1.15 per 1-point rise; 95% CI, 1.05-1.26).
Researchers completed a subgroup analysis in patients with birth weight data and observed the same risk factors in the subgroup of 988 patients (78.1% aged > 12 months; 64% boys; 54.4% nonelective). These patients had increased odds for 30-day mortality after lung biopsy if they had open surgical lung biopsy vs. video-assisted thoracoscopic surgery (OR = 26.32; 95% CI, 3.34-200), a nonelective vs. an elective procedure (OR = 29.84; 95% CI, 3.97-224.45) and a higher ACG score (OR = 1.18 per 1-point rise; 95% CI, 1.06-1.31).
“Cases that are nonelective or those that require open [surgical lung biopsy] procedures may be more complex, in need of urgent pathologic evaluation and have a worse prognosis,” Wee and colleagues wrote. “Similar associations have also been described in the adult literature with elective procedures and [video-assisted thoracoscopic surgery] being associated with lower mortality.”