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Early video-assisted thoracic surgery in the management of empyema
H Grewal1, R J Jackson, C W Wagner
1Department of Surgery, University of Kansas School of Medicine-Wichita, Wichita KS 67208, USA. hrgrewal@worldnet.att.net
Insights
Early video-assisted thoracic surgery (VATS) for pediatric empyema is safe and effective. This approach can reduce hospital stays and associated costs, with a described treatment algorithm for optimal outcomes.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Infectious Diseases
Background:
- The optimal timing and intervention for pediatric empyema remain debated.
- Video-assisted thoracic surgery (VATS) has evolved treatment paradigms for pediatric empyema.
Purpose of the Study:
- To review the early experience with VATS for pediatric empyema.
- To formulate a treatment algorithm based on early VATS intervention.
Main Methods:
- Retrospective review of medical records for children undergoing VATS for empyema.
- Analysis of patient demographics, treatment protocols, and outcomes.
Main Results:
- Twenty-five children with parapneumonic empyema underwent VATS.
- Mean symptom duration was 7.4 days; mean hospitalization was 7.3 days.
- All patients achieved symptom resolution with no recurrences; one required conversion to minithoracotomy.
Conclusions:
- Early VATS intervention for pediatric empyema is safe and effective.
- VATS can potentially reduce hospital length of stay and associated costs.
- An evidence-based treatment algorithm for early VATS in pediatric empyema is presented.
Objective:
The appropriate timing, as well as the type of intervention, for the treatment of empyema in children is controversial. The advent of video-assisted thoracic surgery (VATS) has changed the way we treat these children. Therefore, we reviewed our experience with the early use of VATS in the treatment of empyema and formulated a treatment algorithm.
Methods:
We retrospectively reviewed medical records of all patients undergoing VATS for empyema at Arkansas Children's Hospital from December 1994 to February 1997. All patients were treated by the pediatric surgical service and had the diagnosis of empyema confirmed at surgery. Results are reported as means, unless otherwise noted.
Results:
Twenty-five children with empyema were treated with VATS during the review period. Their age was 48.3 months, and the duration of symptoms was 7.4 days. All the patients had parapneumonic empyemas and had received preoperative antibiotics for 10.1 days. Preoperative imaging included chest radiography in 25 (100%), ultrasonography in 20 (80%), and computed tomography in 10 (40%). All patients with documented loculated parapneumonic fluid collections underwent VATS within a mean of 2 days of hospitalization. Chest tubes were removed in 3.2 days, resulting in a postoperative length of stay of 4.9 days. Total length of stay was 7.3 days. One patient required conversion to minithoracotomy and required a transfusion. There were no other complications or deaths. Follow-up was available for 22 (88%) children, and there was resolution of symptoms in all children with no recurrences.
Conclusions:
Earlier intervention with VATS in the treatment of empyema in children is safe and may reduce hospital charges by shortening hospital stay. A treatment algorithm based on early use of VATS is also described.