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

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. 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. 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. 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. 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]. 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.