title: How early should VATS be performed for retained haemothorax in blunt chest trauma?
abstract: BACKGROUND
  Blunt chest injury is not uncommon in trauma patients. Haemothorax and pneumothorax may occur in these patients, and some of them will develop retained pleural collections. Video-assisted thoracoscopic surgery (VATS) has become an appropriate method for treating these complications, but the optimal timing for performing the surgery and its effects on outcome are not clearly understood.
  
  
  METHODS
  In this study, a total of 136 patients who received VATS for the management of retained haemothorax from January 2003 to December 2011 were retrospectively enrolled. All patients had blunt chest injuries and 90% had associated injuries in more than two sites. The time from trauma to operation was recorded and the patients were divided into three groups: 2-3 days (Group 1), 4-6 days (Group 2), and 7 or more days (Group 3). Clinical outcomes such as the length of stay (LOS) at the hospital and intensive care unit (ICU), and duration of ventilator and chest tube use were all recorded and compared between groups.
  
  
  RESULTS
  The mean duration from trauma to operation was 5.9 days. All demographic characteristics showed no statistical differences between groups. Compared with other groups, Group 3 had higher rates of positive microbial cultures in pleural collections and sputum, longer duration of chest tube insertion and ventilator use. Lengths of hospital and ICU stay in Groups 1 and 2 showed no statistical difference, but were longer in Group 3. The frequency of repeated VATS was lower in Group 1 but without statistically significant difference.
  
  
  CONCLUSIONS
  This study indicated that an early VATS intervention would decrease chest infection. It also reduced the duration of ventilator dependency. The clinical outcomes were significantly better for patients receiving VATS within 3 days under intensive care. In this study, we suggested that VATS might be delayed by associated injuries, but should not exceed 6 days after trauma.
authors.affiliation: Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Trauma, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Emergency Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Hsing-Lin
authors.initials: HL
authors.lastname: Lin
authors.affiliation: Institute of Business and Management, National Chiao Tung University-Taipei, Taipei, Taiwan.
authors.forename: Wen-Yen
authors.initials: WY
authors.lastname: Huang
authors.affiliation: Institute of Business and Management, National Chiao Tung University-Taipei, Taipei, Taiwan.
authors.forename: Chyan
authors.initials: C
authors.lastname: Yang
authors.affiliation: Department of Administration Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Shih-Min
authors.initials: SM
authors.lastname: Chou
authors.affiliation: Shih Chien University-Kaohsiung, Kaohsiung, Taiwan.
authors.forename: Hsin-I
authors.initials: HI
authors.lastname: Chiang
authors.affiliation: Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Trauma, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Emergency Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Liang-Chi
authors.initials: LC
authors.lastname: Kuo
authors.affiliation: Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Trauma, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Emergency Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Tsung-Ying
authors.initials: TY
authors.lastname: Lin
authors.affiliation: Division of Trauma, Department of Emergency, Veterans General Hospital-Kaohsiung, Kaohsiung, Taiwan; Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Kweishan, Taoyuan, Taiwan. Electronic address: chou2763e@yahoo.com.tw.
authors.forename: Yi-Pin
authors.initials: YP
authors.lastname: Chou
mesh_terms: D000293:Adolescent; D000328:Adult; D015505:Chest Tubes / Q000009:adverse effects; D042241:Early Diagnosis; D005260:Female; D006491:Hemothorax / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012189:Retrospective Studies; D013624:Taiwan; D013898:Thoracic Injuries / Q000150:complications / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000601:surgery*
keywords: Blunt injury; Haemothorax; Infection; Length of stay; Thoracic injury; Ventilator; Video-assisted thoracoscopic surgery