VIDEO-ASSISTED THORACIC-SURGERY IN THE TREATMENT OF POSTTRAUMATIC EMPYEMA

Background: Video-assisted thoracic surgery (VATS) appears to be repla cing open thoracotomy for the treatment of posttraumatic thoracic comp lications. Objective: To compare operative times, complication rates, and outcomes in patients who underwent VATS vs open thoracotomy. Desig n: Retrospective review. Setting: University hospital, level I trauma center. Patients: Trauma patients who between December 1993 and May 19 97 underwent open thoracotomy or VATS to drain a persistent thoracic c ollection. Methods: Medical records were reviewed for demographic data , operative times, and clinical outcomes. Results: Of the 524 trauma p atients requiring tube thoracostomy, 22 underwent 23 procedures to dra in empyema (17 VATS, 6 thoracotomies [based on surgeon preference]). T here were no differences in age, Injury Severity Score, or mechanism o f injury between the 2 groups. Three patients who underwent VATS (18%) required conversion to open thoracotomy for adequate drainage. All re maining patients who underwent VATS had successful treatment of their empyema. Complication rates (VATS=29%, open thoracotomy=33%; P=.99), o perative 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 (VA TS=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 e ffective operative strategy for the treatment of posttraumatic empyema . Therefore, because VATS has been shown in nontrauma patients to redu ce morbidity and because it provides better cosmesis, we believe that it should be the initial operative approach to trauma patients with su spected posttraumatic empyema.