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- Title
Making the transition from video-assisted thoracoscopic surgery to chest tube with fibrinolytics for empyema in children: Any change in outcomes?
- Authors
Livingston, Michael H.; Colozza, Sara; Vogt, Kelly N.; Merritt, Neil; Bütter, Andreana
- Abstract
<bold>Background: </bold>There is ongoing variation in the use of video-assisted thoracoscopic surgery (VATS) and chest tube with fibrinolytics (CTWF) for empyema in children. Our objective was to report outcomes from a centre that recently made the transition from VATS to CTWF as the primary treatment modality.<bold>Methods: </bold>We conducted a historical cohort study of children with empyema treated with either primary VATS (between 2005 and 2009) or CTWF (between 2009 and 2013).<bold>Results: </bold>Sixty-seven children underwent pleural drainage for empyema during the study period: 28 (42%) were treated with primary VATS, and 39 (58%) underwent CTWF. There were no significant differences between the VATS and CTWF groups for length of stay (8 v. 9 d, p = 0.61) or need for additional procedures (4% v. 13%, p = 0.19). Length of stay varied widely for both VATS (4-53 d) and CTWF (5-46 d). Primary VATS failed in 1 (4%) patient, who required an additional chest tube, and CTWF failed in 5 (13%) patients. Additional procedures included 3 rescue VATS, 2 additional chest tubes and 1 thoracotomy. All patients recovered and were discharged home.<bold>Conclusion: </bold>Primary VATS and CTWF were associated with similar outcomes in children with empyema. There appears to be a subset of children at risk for treatment failure with CTWF. Further research is needed to determine if these patients would benefit from primary VATS.
- Subjects
VIDEO-assisted thoracic surgery; CHEST tubes; FIBRINOLYTIC agents; EMPYEMA; PEDIATRIC therapy; THERAPEUTICS; THORACIC surgery; LONGITUDINAL method; HEALTH outcome assessment; PARENTERAL infusions; MEDICAL drainage; PHARMACODYNAMICS
- Publication
Canadian Journal of Surgery, 2016, Vol 59, Issue 3, p167
- ISSN
0008-428X
- Publication type
journal article
- DOI
10.1503/cjs.014714