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Primary operative versus nonoperative therapy for pediatric empyema: a meta-analysis
Jeffrey R Avansino1, Bryan Goldman, Robert S Sawin
1Department of Surgery, University of Washington, Box 356410, Seattle, WA 98105, USA. javansin@u.washington.edu
Insights
Primary operative therapy for pediatric empyema significantly reduces mortality, reinterventions, and hospital stay compared to nonoperative treatment. This approach offers a lower risk of treatment failure in children with empyema.
Area of Science:
- Pediatric Surgery
- Thoracic Medicine
- Infectious Diseases
Background:
- Pediatric empyema treatment remains a subject of debate.
- Optimal management strategies require careful consideration of outcomes.
Purpose of the Study:
- To compare nonoperative and primary operative therapies for pediatric empyema.
- To evaluate reported outcomes including mortality, reintervention, and length of stay.
Main Methods:
- A systematic literature review of PubMed (1981-2004) identified studies on pediatric empyema treatment.
- Meta-analysis was performed on studies with sufficient data for comparative outcomes.
- Sixty-seven studies were reviewed, aggregating data from 3418 nonoperative and 363 operative cases.
Main Results:
- Primary operative therapy showed lower in-hospital mortality (0% vs. 3.3%) and reintervention rates (2.5% vs. 23.5%).
- Operative treatment resulted in shorter hospital stays (10.8 vs. 20.0 days), tube thoracostomy duration (4.4 vs. 10.6 days), and antibiotic therapy (12.8 vs. 21.3 days).
- Meta-analysis indicated a pooled relative risk of failure of 0.09 for operative treatment.
Conclusions:
- Primary operative therapy is associated with improved outcomes in pediatric empyema.
- Shorter recovery times and reduced failure rates support operative intervention.
- Operative management offers significant advantages over nonoperative approaches for pediatric empyema.
Objective:
The optimal treatment of children with empyema remains controversial. The purpose of this review was to compare reported results of nonoperative and primary operative therapy for the treatment of pediatric empyema.
Methods:
A systematic comprehensive review of the scientific literature was conducted with the PubMed (National Library of Medicine) database for the period from 1981 to 2004. This reproducible search identified all publications dealing with treatment of empyema in the pediatric population (<18 years of age). A meta-analysis was performed with studies with adequate data summaries for > or =1 of the outcomes of interest for both treatment groups.
Results:
Sixty-seven studies were reviewed. Data were aggregated from reports of children initially treated nonoperatively (3418 cases from 54 studies) and of children treated with a primary operative approach (363 cases from 25 studies). The populations were similar in age. Patients who underwent primary operative therapy had a lower aggregate in-hospital mortality rate (0% vs 3.3%), reintervention rate (2.5% vs 23.5%), length of stay (10.8 vs 20.0 days), duration of tube thoracostomy (4.4 vs 10.6 days), and duration of antibiotic therapy (12.8 vs 21.3 days), compared with patients who underwent nonoperative therapy. In 8 studies for which meta-analysis was possible, patients who received primary operative therapy were found to have a pooled relative risk of failure of 0.09, compared with those who did not. Meta-analysis could not be performed for any of the other outcome measures investigated in this review. Similar complication rates were observed for the 2 groups (5% vs 5.6%).
Conclusions:
These aggregate results suggest that primary operative therapy is associated with a lower in-hospital mortality rate, reintervention rate, length of stay, time with tube thoracostomy, and time of antibiotic therapy, compared with nonoperative treatment. The meta-analysis demonstrates a significantly reduced relative risk of failure among patients treated operatively.
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