Early VATS for blunt chest trauma: a management technique underutilized by acute care surgeons

Jason W Smith, Glen A Franklin, Brian G Harbrecht, J David Richardson
Journal of Trauma 2011, 71 (1): 102-5; discussion 105-7

BACKGROUND: Retained hemothorax and/or empyema is a commonly recognized complication of penetrating chest injuries that may be treated by early video-assisted thoracoscopy (VATS). However, the use of VATS in blunt chest trauma is less well defined. Our acute care surgeon (ACS) group aggressively treats complications of penetrating chest trauma with VATS, and our results suggested that the early use of VATS by ACS should be expanded.

MATERIALS: A retrospective review of Trauma Center admissions between January 2007 and December 2009 was performed to identify patients with blunt thoracic injuries who underwent VATS.

RESULTS: Eighty-three patients underwent VATS to manage thoracic complications arising from their blunt chest trauma. All operations were performed by ACS. The majority of patients (73%, 61 of 83) were treated with VATS for retained hemothorax, 18% for empyema (15 of 83), and 10% for persistent air leak (8 of 83). All (15) patients who developed empyema had chest tubes placed in the emergency department. No patient treated with VATS for a persistent air leak required further operation or conversion to thoracotomy. VATS performed ≤5 days after injury was associated with a lower conversion to open thoracotomy (8% vs. 29.4%, p < 0.05). Hospital length of stay (LOS) was significantly lower for patients receiving VATS ≤5 days after injury (11 ± 6 vs. 16 ± 8, p < 0.05). No patient treated with VATS ≤5 days had persistent empyema; however, five patients treated with VATS for retained hemothorax or empyema >5 days after injury required further intervention for thoracic infection. Multivariate analysis demonstrated that both a diagnosis of empyema and VATS >5 days after injury were predictors of increased LOS and increased conversion to thoracotomy.

CONCLUSIONS: Early VATS can decrease hospital LOS and thoracotomy rate in patient suffering blunt thoracic injuries. ACS can perform this procedure safely and effectively.

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