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Timing to perform VATS for traumatic-retained hemothorax (a systematic review and meta-analysis)

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

In this systematic review, we analyzed the optimal time range to evacuate traumatic-retained hemothorax using video-assisted thoracoscopic surgery (VATS).

Methods

We searched PubMed, EMBASE, the Cochrane Register of Controlled Trials, Google Scholar, and the U.S. National Library of Medicine clinical trials database up to February 2019. Randomized controlled trials (RCTs) and observational studies with relevant data were included. Data were extracted from studies that reported the success, mortality, or length of hospital stay (LOS) after using VATS during at least two out of three of our time-ranges of interest: days 1–3 (group A), days 4–6 (group B), and day 7 or later (group C).

Results

Six cohort studies with 476 total participants were included in the meta-analysis. The patients in group A had a significantly higher success rate than those in group C (RR = 0.42; 95% CI = 0.21–0.84, p = 0.01). The total LOS for patients whose retained hemothorax was evacuated in group A was 4.7 days shorter than that for those in group B (95% CI =  − 5.6 to  − 3.8, p = 0.006). Likewise, group B patients were discharged 18.1 days earlier than group C patients (95% CI =  − 22.3 to  − 14, p < 0.001). Short-term mortality was not decreased by early VATS.

Conclusions

Our results indicate that VATS should be considered within the first three days of admission if this intervention is the clinician's choice to evacuate a traumatic-retained hemothorax.

Protocol registration number in PROSPERO: CRD42017046856

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Tufts Medical Center, 800 Washington Street #1035, Boston, MA, 02111, USA

    Behrad Ziapour

  2. Tabriz University of Medical Sciences, Tabriz, Iran

    Elmira Mostafidi

  3. Department of Statistics and Epidemiology, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran

    Homayoun Sadeghi-Bazargani

  4. Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden

    Homayoun Sadeghi-Bazargani

  5. Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran

    Ali Kabir

  6. Chief of Thoracic Surgery, Division of Cardiovascular and Thoracic Surgery, Program Director, Cardiothoracic Fellowship Program, Division of Cardiothoracic Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-0528, USA

    Ikenna Okereke

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Correspondence to Behrad Ziapour.

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This manuscript has not been published and is not under consideration for publication elsewhere. We have no conflicts of interest to disclose. All authors have read and approved the final version of the manuscript. All the above authors have read and approved the final version of the manuscript and confirm having no conflicts of interest to disclose.

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Ziapour, B., Mostafidi, E., Sadeghi-Bazargani, H. et al. Timing to perform VATS for traumatic-retained hemothorax (a systematic review and meta-analysis). Eur J Trauma Emerg Surg 46, 337–346 (2020). https://doi.org/10.1007/s00068-019-01275-2

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  • DOI: https://doi.org/10.1007/s00068-019-01275-2

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