Fast track pediatric thoracic surgery: Toward day-case surgery?

Abstract Purpose Thoracoscopic lung resection for congenital pulmonary airway malformation (CPAM) is a safe technique for children. Our purpose was to evaluate the feasibility of a fast-track protocol in such cases. Methods From September 2007 to May 2016, 101 patients underwent a thoracoscopic pulm...

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Bibliographic Details
Published in:Journal of pediatric surgery 2017-11, Vol.52 (11), p.1800-1805
Main Authors: Clermidi, Pauline, Bellon, Myriam, Skhiri, Alia, Jaby, Olivier, Vitoux, Christine, Peuchmaur, Michel, Bonnard, Arnaud
Format: Article
Language:English
Subjects:
Children
Congenital pulmonary airway malformation
Fast-track surgery
Fasttack protocol
Pediatrics
Surgery
Thoracoscopy
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Summary:Abstract Purpose Thoracoscopic lung resection for congenital pulmonary airway malformation (CPAM) is a safe technique for children. Our purpose was to evaluate the feasibility of a fast-track protocol in such cases. Methods From September 2007 to May 2016, 101 patients underwent a thoracoscopic pulmonary resection of which 83 for CPAM (lobectomy, wedge resection or sequestrectomy). We retrospectively reviewed the characteristics of surgical procedure, postoperative management and complications through three time periods (September 2007–December 2009: n = 14, January 2010–March 2013: n = 30, April 2013–May 2016: n = 39) corresponding to management protocols modifications introducing fast-track pathways. Results Through the 3 time periods, median postoperative hospital stay decreases (4, 3, 2 days successively, P = 0.02). In the third time period, 4 patients underwent surgery in day-case surgery. The overall and surgical complication rates, mainly related to air leakage, remain stable through the 3 time periods (14%, P = 0.41 and 10%, P = 0.52 respectively). Among the 13 patients without postoperative pleural drainage, one required secondary drainage after a partial resection of an emphysema. Conclusion Fast-track protocol for children undergoing uncomplicated thoracic surgery for CPAM seems feasible without extra morbidity. Selected patient undergoing thoracoscopic resection of the lung may benefit of the absence of pleural drainage and can be operated on in day-case surgery. Level of evidence Level III.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2017.02.005