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Pediatric thymectomy: a study of national trends in demographics, short-term outcomes, and cost

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Abstract

Background

Thymectomy in pediatric patients is an effective treatment for myasthenia gravis (MG), thymic neoplasms, and other rarer pathologies. It is an uncommon procedure in children and studies have focused on small, single-institution cohorts. We sought to better characterize its use by utilizing a national database.

Methods

The Kids’ Inpatient Database was used to identify hospital discharge records of patients ≤ 20 years old who underwent thymectomy. A retrospective cross-sectional analysis for 2003, 2006, 2009, and 2012 was performed. Trends in patient characteristics, diagnosis, surgical approach, and short-term outcomes were analyzed. Risk factors were identified using univariate and multivariate analyses.

Results

There were 600 thymectomies identified. MG was the most common indication. Thoracoscopy is being used increasingly for all diagnoses except malignancy. The overall morbidity rate was 14.0%, with respiratory complications representing the largest group. No in-hospital deaths were identified. Private insurance was associated with shorter hospital stays and lower costs. Hispanic race was associated with more complications, longer stays, and higher costs. Thoracoscopic thymectomies had shorter stays than open procedures.

Conclusion

Thymectomy in the pediatric population is being performed safely, with low morbidity and no identified mortalities. Thoracoscopy results in reduced length of stay and is being used increasingly. Of note, socioeconomic and racial factors impact outcomes.

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Abbreviations

AHRQ:

Agency for Healthcare Research and Quality

HCUP:

Healthcare Cost and Utilization Project

ICD-9-CM:

International Classification of Diseases, Ninth Edition, Clinical Modification

KID:

Kids’ Inpatient Database

MG:

Myasthenia gravis

OR:

Odds ratios

US:

United States

USD:

United States Dollars

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Authors and Affiliations

  1. Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11375, USA

    Michael A. Catalano, Barrie S. Rich & Richard D. Glick

  2. Department of Surgery, Yale University School of Medicine, New Haven, CT, USA

    Clancy W. Mullan

  3. Division of Pediatric Surgery, Cohen Children’s Medical Center, New Hyde Park, 269-01 76th Avenue, Queens, NY, 11040, USA

    Barrie S. Rich & Richard D. Glick

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  1. Michael A. Catalano
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  2. Clancy W. Mullan
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Correspondence to Richard D. Glick.

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Conflict of interest

Michael A. Catalano, BS declares that he has no conflict of interest. Clancy W. Mullan, MD declares that he has no conflict of interest. Barrie S. Rich, MD declares that she has no conflict of interest. Richard D. Glick, MD declares that he has no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors. Patient data was obtained from a publicly available database.

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Catalano, M.A., Mullan, C.W., Rich, B.S. et al. Pediatric thymectomy: a study of national trends in demographics, short-term outcomes, and cost. Pediatr Surg Int 35, 749–757 (2019). https://doi.org/10.1007/s00383-019-04486-1

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