Factors Affecting Outcome Following Video-Assisted Thoracoscopic Surgery for Empyema in Children: Experience from a Large Tertiary Referring Center

Abstract

Abstract

Introduction:

We report the results of video-assisted thoracoscopic surgery (VATS) in a large population of children with empyema, focusing on the factors affecting the postoperative length of stay (LOS).

Materials and Methods:

After ethical approval (RES-18-0000-071Q), a retrospective review was performed (2013–2018). Results are reported as number of cases (%) and median (range) and analyzed by Mann–Whitney U and Kruskal–Wallis tests. Correlation analysis was conducted.

Results:

We identified 159 children with empyema; 75 [42 (56%) males] underwent VATS. Median age was 3.6 (0.4–14.5) years. Presentation was: autumn 15 (20%), winter 26 (35%), spring 18 (24%), summer 16 (21%) with no difference in LOS (P = .6). Preoperative symptoms duration was 7 (2–28) days. Postoperatively, chest drain was on suction in 30 (40%) patients, in situ for 3 (2–13) days. Six (8%) children required further procedures. LOS was 8 (3–47) days. Pleural fluid revealed: Streptococcus species. 41 (55%), other species 8 (11%), no bacteria 26 (34%); LOS was longer with positive pleural fluid: 9 (4–47) versus 6.5 (3–16) days (P = .02). There was no correlation between the LOS and preoperative symptoms duration (r = −0.03 [95% CI −0.3 to 0.2]; P = .7), empyema size (r = 0.2 [95% CI −0.07 to 0.5]; P = .1) and chest drain size (r = 0.09 [95% CI −0.14 to 0.3]; P = .4).

Discussion:

In our experience, >90% of children with empyema will be treated with a single VATS with an average LOS of 8 days. Positive microbiology culture significantly affects the LOS.