Surgery for Bronchiectasis: Experience and Outcomes at Starship Children's Hospital, Auckland, New Zealand.

Abstract

Background: Surgical management for bronchiectasis is uncommon. This study reviewed the experience of bronchiectasis surgery and subsequent outcomes at a tertiary paediatric centre over a 20 year period.

Methods: Retrospective audit of children aged < 18 years who underwent bronchiectasis surgery at Starship Children's Hospital between 2001 and 2021. Cases were identified from clinical coding, with demographics, pre-operative investigations and outcomes obtained from clinical records.

Results: Nineteen children (11 females, 42% Pasifika, 26% Māori and 26% New Zealand European) were included. Mean age of bronchiectasis diagnosis was 6.3 years (range 2.1-13.9 years) and mean age of surgery was 8.5 years (range 2.6-15.9 years). Indications for surgery included localised bronchiectasis (n = 7), main burden of multilobar disease in one lobe (n = 5) and persistent lobar collapse (n = 3). Pre-operative investigations included chest computerised tomography scan (68%), bronchoscopy (37%) and overnight oximetry (42%). One child underwent documented pre-operative clinical optimisation. For children with bronchiectasis < 5 years (n = 11), 81% demonstrated improved symptoms, 9% were unchanged and 9% deteriorated. All children with bronchiectasis > 5 years had symptomatic improvement. The mean number of daily symptoms decreased by 2.4 (p < 0.0001).

Conclusion: Lobectomy resulted in significant symptomatic improvement in 89% of children. However, pre-operative work-up was variable. The study highlights the importance of establishing a protocol for identification of children with bronchiectasis who would benefit from surgery and developing a consistent preparatory approach to ensure optimal and equitable outcomes.