Mortality of Pediatric Surgical Lung Biopsies in Ontario, Canada from 2000-2019.

RATIONALE: Surgical lung biopsies are often required for the definitive diagnosis of non-malignant pediatric diffuse lung diseases, however there is a sparsity of literature on mortality after surgical lung biopsy in pediatric patients.

OBJECTIVES: To determine the 30-day post-operative mortality rate after surgical lung biopsies for non-malignant lung disease in pediatric patients in Ontario, Canada and to identify risk factors associated with mortality.

METHODS: We performed an observational cohort study using population-based health administrative data available from ICES in Ontario, Canada from 2000-2019. Cases were identified using the Canadian Classification of Health Interventions.

INCLUSION CRITERIA: 1) first surgical lung biopsies between 2000-2019, and 2) age <18 years old. Individuals with lung cancer, lung transplant or missing data were excluded. A multivariable logistic regression model, with generalized estimating equation, was used to estimate the 30-day odds of mortality post-surgical lung biopsy and identify patient characteristics associated with increased mortality, while accounting for clustering by hospital.

RESULTS: We identified 1474 pediatric patients who underwent surgical lung biopsy in Ontario between 2000-2019. The overall mortality rates decreased over the study duration from 6.6%(2000-2004) to 3.0%(2015-2019). The study cohort for multi-variate analyses consisted of 1342 patients who had complete data. The pediatric mortality 30-days post-surgical lung biopsy was 5.1% but <1% in elective cases. Risk factors for increased mortality included open surgical lung biopsy (versus video-assisted) [OR 13.13, 95%CI(3.76, 45.87), p<0.001], non-elective procedure [OR 11.74, 95%CI(3.51, 39.27), p<0.001], younger age (<3 months) [OR 6.04, 95%CI(2.40, 15.22), p<0.001] and higher comorbidity score [OR 1.15, 95%CI(1.05, 1.26), p=0.003].

CONCLUSIONS: Pediatric mortality post-surgical lung biopsy is not insignificant, particularly in non-elective procedures. Other important risk factors to consider when pursuing pathologic diagnosis include surgical approach, younger age, and higher comorbidity.