Risk factors for morbidities and mortality in children following pneumonectomy

Background and objectivePneumonectomy (PNE) is a procedure infrequently performed in children. A high morbidity/mortality rate associated with PNE has been described. Few series have been published in the last 15years. Risk factors associated with morbidity/mortality after PNE were evaluated. Indications, course, survival and complications of PNE in children were also analized. MethodsIn a case series of 51 children who underwent PNE, death within 30days of surgery, pneumonia, empyema, sepsis, adult respiratory distress syndrome, bronchopleural fistula, bleeding, pneumothorax and post-PNE syndrome were considered major morbidities. Scoliosis, wound infection and atelectasis were considered minor morbidities. ResultsMedian age at PNE was 7.4years; 45% were males. Indications of pneumonectomy were postinfectious bronchiectasis (61%), tumours (17%), pulmonary malformations (17%), aspiration syndrome (14%), cystic fibrosis (6%), immunodeficiency (4%) and trauma (2%). Mortality rate was 4% at 1month. Major and minor morbidities were present in 23% and 27% of patients, respectively. Risk factors for development of morbidities after PNE were age3years (OR: 16.7; 95% CI: 2.4-117) and the need for mechanical ventilation for at least 4days (OR: 8; 95% CI: 1.5-43.6). ConclusionChildren are at high risk of death, major and minor morbidities following PNE. Caution is recommended for this group of patients. Risk factors related to morbidity and mortality after pneumonectomy (PNE) have been described in adults. This study explores the risk factors following PNE in children. Age 3years and the need for ventilation assistance for 4days or longer was associated with increased risk of morbidity and mortality.