Surgical Outcomes in Pediatric Patients with Infantile Hemangioma: A Retrospective Case-Control Study
Nikita S. Goel, M.D.1, Katherine A. Grunzweig, M.D.2, Anand R. Kumar, M.D.2.
1University of North Carolina, Chapel Hill, NC, USA, 2University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Purpose: The efficacy of medical pretreatment prior to surgical excision of infantile hemangiomas (IH) remains understudied. The objective of this study was to determine if patients undergoing surgical excision for IH had improved outcomes with medical pre-treatment prior to excision.
Methods: A retrospective chart review of patients between 2007-2018 at a pediatric tertiary center was conducted. Inclusion criteria included children aged 0-10 years, who underwent surgical resection with a confirmed GLUT-1 positive IH by immunostaining. Exclusion criteria included a history of PHACE syndrome, visceral hemangiomas, Kasabach-Merritt syndrome, and congenital hemangiomas. Outcomes assessed were medical pre-treatment, length of follow-up, post-operative wound dehiscence, infection, visual analog scores (VAS), and secondary procedures.
Results: Of 185 IH patients identified, 85 (46%) underwent surgical resection. Twenty-two patients (25.89%) were male, 74.11% were Caucasian, and 57.65% lesions were located on the face. Fifty-seven had no pre-treatment (NPT), 28 received pre-treatment (PT): 8.24% propranolol, 9.41% topical timolol, 12.94% primarily systemic steroids, and 2.35% laser. Median length of medical management was 2.5 months. Pre-operative ulceration was present in 24.7% and bleeding in 15.29%. Functional impairment noted preoperatively for 2.35% PT and 3.52% NPT. Median lesion size was 5cm2. There was no difference between PT and NPT lesion sizes (p=0.829). Median age at surgery was 14 months. Median first post-operative follow-up was 25 days. Wound dehiscence, infection, VAS, and repeat surgery were not significantly different (p=0.162, 1.0, 1.0, 0.483). Pre-treatment did have more incidences of documented functional improvement (p=0.039). When all negative outcomes were pooled, there was no significant difference in incidence between PT and NPT (p=0.448). Beta-blockers versus NPT also had consistently similar results (p=0.57, 0.468, 0.679, 0.005, 0.672).
Conclusions: PT prior to surgical excision of IH was not found to improve early patient outcomes. Our study supports that neither pre-treatment nor direct to surgery patients have different rates of negative outcomes, and therefore surgical planning may be performed with patient specific factors in mind.
|Outcomes||PT (n=28)||NPT (n=57)||All categories**#||All PT vs NPT##||Beta-blockers vs NPT|
|Wound dehiscence||0||10.42% (5/48)||NA||0.162||0.573|
|Infection||4% (1/24)||4.17% (2/48)||0.536||1.000||0.468|
|Scarring||20.83% (5/24)||18.75% (9/48)||0.757||1.000||0.679|
|Functional improvement||4 documented||1 documented||0.006||0.039||0.005|
|Repeat surgery||7.14% (2/28)||14.29% (8/56)||0.225||0.483||0.672|
|All negative outcomes*||45.83% (11/24)||35.4% (17/48)||0.444||0.448||0.731|
*Wound dehiscence, infection, scarring, erythema, edema, repeat surgery; **Propranolol, vs topical timolol, vs steroids, vs laser, vs NPT; # Pearson's chi-squared test; ## Fisher's exact test
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