Video-assisted thoracic surgery in the treatment of posttraumatic empyema

L A Scherer, F D Battistella, J T Owings, M M Aguilar
Archives of Surgery 1998, 133 (6): 637-41; discussion 641-2

BACKGROUND: Video-assisted thoracic surgery (VATS) appears to be replacing open thoracotomy for the treatment of posttraumatic thoracic complications.

OBJECTIVE: To compare operative times, complication rates, and outcomes in patients who underwent VATS vs open thoracotomy.

DESIGN: Retrospective review.

SETTING: University hospital, level I trauma center.

PATIENTS: Trauma patients who between December 1993 and May 1997 underwent open thoracotomy or VATS to drain a persistent thoracic collection.

METHODS: Medical records were reviewed for demographic data, operative times, and clinical outcomes.

RESULTS: Of the 524 trauma patients requiring tube thoracostomy, 22 underwent 23 procedures to drain empyema (17 VATS, 6 thoracotomies [based on surgeon preferencel). There were no differences in age, Injury Severity Score, or mechanism of injury between the 2 groups. Three patients who underwent VATS (18%) required conversion to open thoracotomy for adequate drainage. All remaining patients who underwent VATS had successful treatment of their empyema. Complication rates (VATS=29%, open thoracotomy=33%; P=.99), operative times (VATS=3.4+/-1.3 hours [mean+/-SD], open thoracotomy=3.0+/-1.5 hours; P=.46), postoperative epidural catheter use (VATS=31%, open thoracotomy=50%; P=.63), duration of chest tube drainage (VATS=5.1+/-1.7 days [mean+/-SD], open thoracotomy=4.5+/-1.5 days; P=.48), and hospital stay after the procedure (VATS=16+/-14 days [mean+/-SD], open thoracotomy=11+/-5 days; P=.39) were similar for both groups.

CONCLUSIONS: Video-assisted thoracic surgery was a safe and effective operative strategy for the treatment of posttraumatic empyema. Therefore, because VATS has been shown in nontrauma patients to reduce morbidity and because it provides better cosmesis, we believe that it should be the initial operative approach to trauma patients with suspected posttraumatic empyema.

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