Post-Operative Hemothorax: Uniportal Video-Assisted Thoracic Surgery vs Thoracotomy-Analysis of Outcomes and Costs

Post-operative hemothorax (PH) is one of the most critical complications in thoracic surgery, which requires prompt treatment. The aim of the study is to review the consecutive series of patients with PH undergoing re-operation in Uniportal Video-Assisted Thoracic Surgery (U-VATS) or Thoracotomy, analyzing the outcomes and costs. Out of 1663 patients undergone Thoracic operations (pulmonary resections, esophagectomies, or pleural/chest wall lesions) between 2016 and 2024, 52 (3.12%) developed a PH and underwent surgical treatment. Data of patients were collected and retrospectively analyzed. Thirty-six patients were male (69.23%), with a mean age of 62.54 ± 16.46 years. Active bleeding was intraoperatively discovered in a total of 35 patients (67.30%). Most of the patients who developed PH had undergone a previous wedge resection (20, 38.46%) and in 15 cases (28.84%), the cause was pleural/parenchyma bleeding. Post-operative complications were significantly higher in the group of patients who underwent treatment of PH by thoracotomy (10 (34.48%) vs 2 (8.69%), P:0.028), and 14 patients (48.27%) required ICU admission(P:0.020). Patients with post-operative complications had a significantly longer hospital-stay (9.33 ± 5.02 vs 4.83 ± 2.09 days: <0.001). In general, post-operative hospital-stay was also longer in the thoracotomy group (7.07 ± 3.83 vs 4.35 ± 2.44 days, P:0.005). Total costs, including operating room expenses, hospital-stay, and ICU admission, were higher in the open group compared to U-VATS(6708.94 ± 2738.74 vs 5238.79 ± 2527.92€, P:0.052). Multivariable analysis identified the open approach as the only independent risk factor for complications (OR = 5.53, 95%CI [1.072-28.49], P:0.041). Open approach exposes to higher post-operative complications and costs, with longer hospital stay in case of reoperation for PH. U-VATS technique seems to be safe and effective and with lower costs, although the instruments are more expensive.