Advertisement

Pediatric Surgery International

, Volume 26, Issue 4, pp 367–371 | Cite as

Complications and treatment failures of video-assisted thoracoscopic debridement for pediatric empyema

  • Andreas H. Meier
  • Clayton B. Hess
  • Robert E. Cilley
Original Article

Abstract

Purpose

Video-assisted thoracoscopic debridement (VATD) is a well-established intervention to treat pediatric empyema. There is ongoing controversy at what stage in the treatment algorithm it should be utilized. To shed further light onto this debate, we reviewed our institutional experience looking for factors predicting treatment failure or complications of VATD.

Methods

We retrospectively analyzed data on patients that had undergone VATD for empyema from 1995 to 2008. We used independent sample t tests and Chi-square tests (SPSS) for statistical analysis.

Results

One hundred and fifty-two procedures in 151 patients [81 male (53.6%)] were identified. In 146 (96.7%) the etiology of the empyema was pulmonary, in 3 (1.98%) due to an infectious abdominal process and in 2 (1.3%) due to abdominal trauma. 118 patients (78.1%) were transferred from outside hospitals. 107 (70.1%) underwent VATD primarily, 44 (29.1%) following another procedure. The overall complication rate was 13.8%, most of which were minor. Treatment failures occurred in seven patients, resulting in three reoperations; two patients died. The average length of stay was 10.1 days, but was significantly longer if VATD followed another procedure or if a complication occurred. The risk for complications correlated with older age (6.2 vs. 8.8 years, p = 0.023) and lower hematocrit on admission (31.1 vs. 27.9%, p = 0.006).

Conclusions

VATD provided effective treatment for pediatric empyema. Complications were mostly minor, occurring more frequently in older patients and those with a lower admission hematocrit. Early VATD decreased the length of hospitalization.

Keywords

Empyema Minimally invasive surgery Video-assisted thoracoscopic surgery VATD VATS Complications 

References

  1. 1.
    Avansino JR, Goldman B, Sawin RS et al (2005) Primary operative versus nonoperative therapy for pediatric empyema: a meta-analysis. Pediatrics 115:1652–1659CrossRefPubMedGoogle Scholar
  2. 2.
    Li ST (2008) Gates RL: primary operative management for pediatric empyema: decreases in hospital length of stay and charges in a national sample. Arch Pediatr Adolesc Med 162:44–48CrossRefPubMedGoogle Scholar
  3. 3.
    Chan DT, Sihoe AD, Chan S et al (2007) Surgical treatment for empyema thoracis: is video-assisted thoracic surgery “better” than thoracotomy? Ann Thorac Surg 84:225–231CrossRefPubMedGoogle Scholar
  4. 4.
    Cohen G, Hjortdal V, Ricci M et al (2003) Primary thoracoscopic treatment of empyema in children. J Thorac Cardiovasc Surg 125:79–83 (discussion 83–74)CrossRefPubMedGoogle Scholar
  5. 5.
    Colice GL, Curtis A, Deslauriers J et al (2000) Medical and surgical treatment of parapneumonic effusions: an evidence-based guideline. Chest 118:1158–1171CrossRefPubMedGoogle Scholar
  6. 6.
    Hope WW, Bolton WD, Stephenson JE (2005) The utility and timing of surgical intervention for parapneumonic empyema in the era of video-assisted thoracoscopy. Am Surg 71:512–514PubMedGoogle Scholar
  7. 7.
    Kercher KW, Attorri RJ, Hoover JD et al (2000) Thoracoscopic decortication as first-line therapy for pediatric parapneumonic empyema. A case series. Chest 118:24–27CrossRefPubMedGoogle Scholar
  8. 8.
    Ripley RT, Cothren CC, Moore EE et al (2006) Streptococcus milleri infections of the pleural space: operative management predominates. Am J Surg 192:817–821CrossRefPubMedGoogle Scholar
  9. 9.
    Solaini L, Prusciano F, Bagioni P (2007) Video-assisted thoracic surgery in the treatment of pleural empyema. Surg Endosc 21:280–284CrossRefPubMedGoogle Scholar
  10. 10.
    Wong KS, Lin TY, Huang YC et al (2005) Scoring system for empyema thoracis and help in management. Indian J Pediatr 72:1025–1028CrossRefPubMedGoogle Scholar
  11. 11.
    Wurnig PN, Wittmer V, Pridun NS et al (2006) Video-assisted thoracic surgery for pleural empyema. Ann Thorac Surg 81:309–313CrossRefPubMedGoogle Scholar
  12. 12.
    Huang HC, Chang HY, Chen CW et al (1999) Predicting factors for outcome of tube thoracostomy in complicated parapneumonic effusion for empyema. Chest 115:751–756CrossRefPubMedGoogle Scholar
  13. 13.
    Lardinois D, Gock M, Pezzetta E et al (2005) Delayed referral and gram-negative organisms increase the conversion thoracotomy rate in patients undergoing video-assisted thoracoscopic surgery for empyema. Ann Thorac Surg 79:1851–1856CrossRefPubMedGoogle Scholar
  14. 14.
    Cameron R, Davies HR (2008) Intra-pleural fibrinolytic therapy versus conservative management in the treatment of adult parapneumonic effusions and empyema. Cochrane Database Syst Rev 2008:CD002312Google Scholar
  15. 15.
    Meier AH, Smith B, Raghavan A et al (2000) Rational treatment of empyema in children. Arch Surg 135:907–912CrossRefPubMedGoogle Scholar
  16. 16.
    St Peter SD, Tsao K, Spilde TL et al (2009) Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children: a prospective, randomized trial. J Pediatr Surg 44:106–111 (discussion 111)CrossRefPubMedGoogle Scholar
  17. 17.
    Chen CY, Chen JS, Huang LM et al (2003) Favorable outcome of parapneumonic empyema in children managed by primary video-assisted thoracoscopic debridement. J Formos Med Assoc 102:845–850PubMedGoogle Scholar
  18. 18.
    Coote N, Kay E (2005) Surgical versus non-surgical management of pleural empyema. Cochrane Database Syst Rev 2005:CD001956Google Scholar
  19. 19.
    Gates RL, Caniano DA, Hayes JR et al (2004) Does VATS provide optimal treatment of empyema in children? A systematic review. J Pediatr Surg 39:381–386CrossRefPubMedGoogle Scholar
  20. 20.
    Goldschlager T, Frawley G, Crameri J et al (2005) Comparison of thoracoscopic drainage with open thoracotomy for treatment of paediatric parapneumonic empyema. Pediatr Surg Int 21:599–603CrossRefPubMedGoogle Scholar
  21. 21.
    Sunder-Plassmann L (1998) Pleural empyema. Chirurg 69:821–827CrossRefPubMedGoogle Scholar
  22. 22.
    Molnar TF (2007) Current surgical treatment of thoracic empyema in adults. Eur J Cardiothorac Surg 32:422–430CrossRefPubMedGoogle Scholar
  23. 23.
    Roberts JR (2003) Minimally invasive surgery in the treatment of empyema: intraoperative decision making. Ann Thorac Surg 76:225–230 (discussion 229–230)CrossRefPubMedGoogle Scholar
  24. 24.
    Fuller MK, Helmrath MA (2007) Thoracic empyema, application of video-assisted thoracic surgery and its current management. Curr Opin Pediatr 19:328–332CrossRefPubMedGoogle Scholar
  25. 25.
    Lackner RP, Hughes R, Anderson LA et al (2000) Video-assisted evacuation of empyema is the preferred procedure for management of pleural space infections. Am J Surg 179:27–30CrossRefPubMedGoogle Scholar
  26. 26.
    Cassina PC, Hauser M, Hillejan L et al (1999) Video-assisted thoracoscopy in the treatment of pleural empyema: stage-based management and outcome. J Thorac Cardiovasc Surg 117:234–238CrossRefPubMedGoogle Scholar
  27. 27.
    Tan TQ, Mason EO Jr, Barson WJ et al (1998) Clinical characteristics and outcome of children with pneumonia attributable to penicillin-susceptible and penicillin-nonsusceptible Streptococcus pneumoniae. Pediatrics 102:1369–1375CrossRefPubMedGoogle Scholar
  28. 28.
    Roseby R (2006) Primary operative versus nonoperative therapy for pediatric empyema. Pediatrics 117:1462–1463CrossRefPubMedGoogle Scholar
  29. 29.
    Tokuda Y, Matsushima D, Stein GH et al (2006) Intrapleural fibrinolytic agents for empyema and complicated parapneumonic effusions: a meta-analysis. Chest 129:783–790CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Andreas H. Meier
    • 1
  • Clayton B. Hess
    • 2
  • Robert E. Cilley
    • 3
  1. 1.Division of Pediatric Surgery, Department of Surgery, School of MedicineSouthern Illinois UniversitySpringfieldUSA
  2. 2.Penn State Hershey College of MedicineThe Pennsylvania State UniversityPalmyraUSA
  3. 3.MSHMC Pediatric Surgery, Penn State Hershey College of MedicineThe Pennsylvania State UniversityHersheyUSA

Personalised recommendations