Early evacuation of traumatic retained hemothoraces using thoracoscopy: a prospective, randomized trial.
BACKGROUND
Failure to adequately evacuate blood from the pleural space after trauma may result in extended hospitalization and complications such as empyema.


METHODS
Patients with retained hemothoraces were prospectively randomized to either a second tube thoracostomy (group 1, n = 24) or video-assisted thoracoscopy (VATS) (group 2, n = 15). Group 1 patients in whom additional tube drainage failed were subsequently randomized to either VATS or thoracotomy. Study end points included duration and costs of hospitalization.


RESULTS
During a 4-year period, 39 patients were entered into the study. Patients in group 2 had shorter 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 +/- 3,278 versus $13,273 +/- 8,158; p < 0.02). There was no mortality in either group. No group 2 patient required conversion to thoracotomy. In 10 group 1 patients additional tube placement failed, and this subset was randomized to VATS (n = 5) or thoracotomy (n = 5). No significant difference in clinical outcome was found between these subgroups.


CONCLUSIONS
In many patients treated only with additional tube drainage (group 1), this therapy fails, necessitating further intervention. Intent to treat with early VATS for retained hemothoraces decreases the duration 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.
Meyer
D M
DM
Department of Surgery, University of Texas Southwestern Medical Center at Dallas 75235-8879, USA. dmeyer@mednet.swmed.edu
Jessen
M E
ME
Wait
M A
MA
Estrera
A S
AS
D000293:Adolescent; D000328:Adult; D015505:Chest Tubes; D005260:Female; D006491:Hemothorax / Q000191:economics / Q000209:etiology / Q000628:therapy*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013898:Thoracic Injuries / Q000150:complications*; D013906:Thoracoscopy; D013908:Thoracotomy; D013997:Time Factors; D016896:Treatment Outcome