Comparing the timing of surgery for congenital lung malformations in children throughout the United States.
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INTRODUCTION: Timing and approach to the surgical resection of congenital lung malformations (CLMs) in infancy are driven by severity of symptoms, potential for malignancy and infection risk. There are currently no standards to the management CLMs. Therefore, we compared practice variations for CLMs in infants throughout the US. METHODS: The Nationwide Readmissions Database for 2016-2020 was queried for all patients under 1 year of age with three different categories for timing of resection of CLM: within 4 months (early), between 4 and 6 months (intermediate), and 6-12 months (late). Outcomes included prolonged length of stay (LOS >3 days), prolonged mechanical ventilation (>96 h), blood transfusions, readmission, and mortality. RESULTS: Of the 615 patients included, timing of surgery was nearly evenly distributed with early surgery among 186 (30.3 %), intermediate surgery among 221 (35.9 %), and late among 208 (33.8 %) patients. Although 36 % of patients overall underwent an open procedure, this rate significantly decreased with age, 44 % in patients younger than 4 months compared to 27 % in those older than 6 months (p = 0.002). Multivariable logistic regression revealed no statistical difference between early and intermediate surgery, while late surgery was associated with a decreased risk for prolonged LOS (OR 0.41 [0.25-0.67, p < 0.001] and 30-day readmission to the same hospital (OR 0.06 [0.02-0.18, p < 0.001]. CONCLUSIONS: This study demonstrates that the timing of surgery for CLMs in children varies significantly across the US and timing of surgery may impact patient outcomes. Further research is needed to refine our understanding of the optimal timing of surgery.