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Early evacuation of traumatic retained hemothoraces using thoracoscopy: a prospective, randomized trial
D M Meyer1, M E Jessen, M A Wait
1Department of Surgery, University of Texas Southwestern Medical Center at Dallas 75235-8879, USA. dmeyer@mednet.swmed.edu
The Annals of Thoracic Surgery
|December 5, 1997
Summary
Early video-assisted thoracoscopy (VATS) for retained hemothoraces after trauma significantly reduces tube drainage duration, hospital stay, and costs compared to traditional tube thoracostomy. This approach offers a more efficient and economical management strategy.
Area of Science:
- Thoracic Surgery
- Trauma Management
- Minimally Invasive Procedures
Background:
- Inadequate evacuation of pleural blood post-trauma can lead to prolonged hospitalization and complications like empyema.
- Retained hemothoraces present a significant challenge in trauma care.
Purpose of the Study:
- To compare the efficacy and cost-effectiveness of video-assisted thoracoscopy (VATS) versus secondary tube thoracostomy for managing retained hemothoraces.
- To evaluate the impact of early VATS intervention on patient outcomes and healthcare resource utilization.
Main Methods:
- Prospective randomized study of 39 trauma patients with retained hemothoraces.
- Group 1: Secondary tube thoracostomy; Group 2: Video-assisted thoracoscopy (VATS).
- Patients in Group 1 with drainage failure were further randomized to VATS or thoracotomy.
Main Results:
- VATS group (Group 2) demonstrated significantly shorter tube drainage duration (2.53 days vs. 4.50 days).
- VATS led to shorter post-procedure hospital stays (3.60 days vs. 7.21 days) and reduced total hospital stay (5.40 days vs. 8.13 days).
- Hospital costs were substantially lower in the VATS group ($7,689 vs. $13,273), with no mortality in either group.
Conclusions:
- Secondary tube thoracostomy frequently fails, necessitating further intervention for retained hemothoraces.
- Early VATS intervention is a more efficient and cost-effective strategy for managing retained hemothoraces.
- VATS significantly decreases hospital resource utilization and patient recovery time.