DELAYED REFERRAL REDUCES THE SUCCESS OF VIDEO-ASSISTED THORACOSCOPIC SURGERY FOR SPONTANEOUS PNEUMOTHORAX

Background. Video-assisted thoracoscopic surgery (VATS) is now the gen erally preferred surgical treatment for spontaneous pneumothorax but i s more difficult once pleural adhesions have developed. To test the hy pothesis that VATS is under-used because of prolonged pleural intubati on, we have audited the effect of preoperative management on subsequen t surgical outcome. Method. Data are expressed as median (range). A pr ospective audit of clinical outcome in 42 consecutive patients (30 mal e, 12 female, aged 39 [19-81] years) referred to a Regional Unit for n on-elective pneumothorax surgery. VATS was attempted whenever possible . Results. VATS was successful in 32 patients (group V) but 10 (24%) p atients (group T) required thoracotomy and decortication of an empyema thoracis. Only seven (17%) patients were operated upon within 7 days of presentation, and 10 patients (24%) waited for more than 21 days. T he delay from presentation to operation was significantly longer in gr oup T (22 days vs. 10 days, P<0.05, Wilcoxon). There were significantl y more preoperative pleural interventions in patients in group T than in group V (P<0.05, Wilcoxon). Postoperative stay was longer in group T (7 days vs. 3 days, P<0.05) and there was a significant overall corr elation between preoperative delay and postoperative stay (r=0.64). Co nclusion. Delayed referral for pneumothorax surgery and multiple pleur al interventions predispose to pleural sepsis and preclude VATS detrim entally affecting clinical outcome. Changes in referral practice are a dvocated.