High Dependency Unit (HDU) requirement following thoracoscopic resection for congenital lung malformation

Where surgery is deemed appropriate for congenital lung malformations (CLM), early thoracoscopic resection is favoured. Routine post-operative high dependency unit (HDU) care risks procedure delay or cancellation if HDU is unavailable on the day. We hypothesised that only a minority of patients genuinely require post op HDU care.

A retrospective study (2013–2022). Patients who underwent thoracoscopic CLM resection were identified from electronic records. Data included Paediatric Early Warning Score (PEWS), complications and HDU interventions. PEWS measurements were noted. PEWS greater than 6 was defined as one that would trigger critical care team review. Data as mean, standard deviation (SD), median and interquartile range (IQR), p value of ≤ 0.05 was considered significant.

72 patients with median age 12 (9–17.2) months. 83% (n = 60) of procedures were completed thoracoscopically. 35 (49%) were admitted onto the surgical ward from recovery and 37 (51%) onto HDU. Median HDU stay was 24 (18–41) h, with 21 (57%) patients being stepped down within 24 h of admission. Only 5.6% of entire cohort scored PEWS 6 and above.

Following thoracoscopic CLM resection, the majority of patients can safely be admitted onto a surgical ward with critical care outreach team support as required.