O2093: Surgeon Volume and Postoperative Outcomes After Elective Lung Resection in Infants with Congenital Lung Malformations

Background: Although the surgeon volume-outcome association is well established for many operations in adults, few studies have evaluated this relationship for major index cases in pediatric surgery. This study evaluated the association between pediatric surgeon volume and postoperative outcomes in infants undergoing elective lung resection for asymptomatic congenital lung malformation (CLM).

Methods: After IRB approval, infants aged >30 days who underwent elective resection for an asymptomatic CLM were identified in the Pediatric Health Information System database (2016-2020). Annual lung resection case volume were used to classify pediatric surgeons into low (≤ 1 case), medium (1-3 cases), or high (≥3 cases) volume groups. Outcomes of hospital length of stay (LOS) and postoperative complications, including ICU stay, reintubation, ventilation, pneumothorax, pneumonia, readmissions, reoperation, and death, were compared between tertiles using linear and Poisson multivariable regression to adjust for confounding. A subgroup analysis of surgeons practicing at higher volume centers (> 8 annual cases per year) was also performed.

Results: There were 309 surgeons who performed elective lung resections on 1327 infants with a CLM, including congenital pulmonary airway malformations (n=583, 44%) and bronchopulmonary sequestrations (n=335, 25%). The median age at operation was 180 days (IQR 117.8-243 days). There were 251 low volume, 40 medium volume, and 18 high volume surgeons (see Figure). The average annual case volume for low, medium, and high volume groups was 0.64+/-0.29, 1.74+/-0.47, and 9.19+/-6.39, respectively. The median postoperative LOS was 2 days (IQR, 2-3 days) in each group. Overall postoperative complications were significantly different across tertiles for low (28%), medium (20%), and high volume surgeons (20%, p=0.006, Table). Respiratory complications were also significantly different for low (26%), medium (17%), and high volume (18%) surgeons (p=0.004). After controlling for operative approach, age, lesion type, sex, race, and year, low volume surgeons were associated with a 0.4 day increased LOS (95% CI 0.09-0.79, p=0.013), an odds ratio of 1.91 for respiratory complications (95% CI 1.22-3.00, p=0.005), and an odds ratio of 1.71 for any complication (CI 1.15-2.54, p=0.008). There were no differences in readmissions (p=0.144) or billing charges (p=0.280) based on surgeon volume. On subgroup analysis, low volume surgeons who practiced at medium/high volume centers had no differences in LOS, respiratory, or any complications when compared to higher volume surgeons at the same institutions (p>0.1).

Conclusion: Among pediatric surgeons performing elective lung resections for infants with CLMs, low lung resection volumes are associated with longer hospital LOS as well as increased postoperative respiratory and overall complication rates. Given that most pediatric surgeons are low volume surgeons, these data suggest that quality improvement initiatives should be instituted to ensure optimal clinical outcomes for these asymptomatic infants.