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Article
Making the transition from video-assisted thoracoscopic surgery to chest tube with fibrinolytics for empyema in children: Any change in outcomes?
Canadian Journal of Surgery
  • Michael H. Livingston, Western University
  • Sara Colozza, Schulich School of Medicine & Dentistry
  • Kelly N. Vogt, Western University
  • Neil Merritt, Western University
  • Andreana Bütter, Western University
Document Type
Article
Publication Date
6-1-2016
URL with Digital Object Identifier
10.1503/cjs.014714
Abstract

Background: There is ongoing variation in the use of video-assisted thoracoscopic surgery (VATS) and chest tube with fibrinolytics (CTWF) for empyema in children. Our objective was to report outcomes from a centre that recently made the transition from VATS to CTWF as the primary treatment modality. Methods: We conducted a historical cohort study of children with empyema treated with either primary VATS (between 2005 and 2009) or CTWF (between 2009 and 2013). Results: Sixty-seven children underwent pleural drainage for empyema during the study period: 28 (42%) were treated with primary VATS, and 39 (58%) underwent CTWF. There were no significant differences between the VATS and CTWF groups for length of stay (8 v. 9 d, p = 0.61) or need for additional procedures (4% v. 13%, p = 0.19). Length of stay varied widely for both VATS (4-53 d) and CTWF (5-46 d). Primary VATS failed in 1 (4%) patient, who required an additional chest tube, and CTWF failed in 5 (13%) patients. Additional procedures included 3 rescue VATS, 2 additional chest tubes and 1 thoracotomy. All patients recovered and were discharged home. Conclusion: Primary VATS and CTWF were associated with similar outcomes in children with empyema. There appears to be a subset of children at risk for treatment failure with CTWF. Further research is needed to determine if these patients would benefit from primary VATS.

Citation Information
Michael H. Livingston, Sara Colozza, Kelly N. Vogt, Neil Merritt, et al.. "Making the transition from video-assisted thoracoscopic surgery to chest tube with fibrinolytics for empyema in children: Any change in outcomes?" Canadian Journal of Surgery Vol. 59 Iss. 3 (2016) p. 167 - 171
Available at: http://works.bepress.com/neil-merritt/4/