EARLY EVACUATION OF TRAUMATIC RETAINED HEMOTHORACES USING THORACOSCOPY - A PROSPECTIVE, RANDOMIZED TRIAL

Background. Failure to adequately evacuate blood from the pleural spac e after trauma may result in extended hospitalization and complication s such as empyema. Methods. Patients with retained hemothoraces were p rospectively randomized to either a second tube thoracostomy (group 1, n = 24) or video-assisted thoracoscopy (VATS) (group 2, n = 15). Grou p 1 patients in whom additional tube drainage failed were subsequently randomized to either VATS or thoracotomy. Study end points included d uration and costs of hospitalization. Results. During a 4-year period, 39 patients were entered into the study. Patients in group 2 had shor ter duration of tube drainage (2.53 +/- 1.36 versus 4.50 +/- 2.83 days , mean +/- standard deviation; p < 0.02), shorter hospital stay after the procedure (3.60 +/- 1.64 versus 7.21 +/- 5.30 days; p < 0.02), and shorter total hospital stay (5.40 +/- 2.16 versus 8.13 +/- 4.62 days; p < 0.02). Hospital costs were also]less in this group ($7,689 a 3,27 8 versus $13,273 +/- 8,158; p < 0.02), There was no mortality in eithe r group. No group 2 patient required conversion to thoracotomy. In 10 group I patients additional tube placement failed, and this subset was randomized to VATS (n = 5) or thoracotomy (n = 5). No significant dif ference in clinical outcome was found between these subgroups. Conclus ions. In many patients treated only with additional tube drainage (gro up 1), this therapy fails, necessitating mg further intervention.]inte nt to treat with early VATS for retained hemothoraces deceases the dur ation of tube drainage, the length of hospital stay, and hospital cost . Early intervention with VATS may be a more efficient and economical strategy for managing retained hemothoraces after trauma. (C) 1997 by The Society of Thoracic Surgeons.