title: A comparison of video-assisted thoracoscopic surgery with open thoracotomy for the management of chest trauma: a systematic review and meta-analysis.
abstract: BACKGROUND
  This study aimed to systematically review and compare the perioperative outcomes of video-assisted thoracoscopy (VATS) with open thoracotomy for chest trauma patients.
  
  
  METHODS
  We conducted a systematic review and meta-analysis of randomized control trials and cohort studies comparing the perioperative outcomes of VATS with open thoracotomy for chest trauma patients. Clinical endpoints included postoperative complications, perioperative mortality rate, chest tube drainage volume, duration of tube drainage, duration of hospitalization, operation time, and amount of bleeding and transfusion volume in operation. A subgroup analysis was performed to explore the potential source of heterogeneity.
  
  
  RESULTS
  Twenty-six studies were included. Pooled analyses showed significant reductions in the incidence of postoperative complications (risk ratio [RR] [95% confidence interval (CI)], 0.47 [0.35, 0.64]), chest tube drainage volume (mean difference [MD] [95% CI], -146.88 ml [-196.04, -97.72]), duration of tube drainage (MD, -1.71 days; 95% CI -2.16 to -1.26), duration of hospitalization (MD, -4.67 days; 95% CI -5.19 to-4.14), operation time (MD, -41.18 min; 95% CI -52.85 to -29.51), and amount of bleeding (MD, -119.10 ml; 95% CI -147.28 to -90.92) and transfusion volume (MD, -379.51 ml; 95% CI -521.24 to-237.77) in chest trauma patients treated with VATS compared with open thoracotomy. The perioperative mortality rate was not significantly different between patients received VATS and open thoracotomy (RR, 0.52; 95% CI 0.22-1.21).
  
  
  CONCLUSIONS
  Compared to open thoracotomy, VATS is an effective and even better treatment for improving perioperative outcomes of hemodynamically stable patients with chest trauma and reduce the complications. However, caution should also be exercised in certain clinical scenarios.
authors.affiliation: Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing, 400038, People's Republic of China, cqwuna@126.com.
authors.forename: Na
authors.initials: N
authors.lastname: Wu
authors.forename: Long
authors.initials: L
authors.lastname: Wu
authors.forename: Chongying
authors.initials: C
authors.lastname: Qiu
authors.forename: Zubin
authors.initials: Z
authors.lastname: Yu
authors.forename: Ying
authors.initials: Y
authors.lastname: Xiang
authors.forename: Minghao
authors.initials: M
authors.lastname: Wang
authors.forename: Jun
authors.initials: J
authors.lastname: Jiang
authors.forename: Yafei
authors.initials: Y
authors.lastname: Li
mesh_terms: D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D015505:Chest Tubes; D015331:Cohort Studies; D004322:Drainage; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D061646:Operative Time; D059035:Perioperative Period; D016032:Randomized Controlled Trials as Topic; D013898:Thoracic Injuries / Q000401:mortality / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000401:mortality; D013908:Thoracotomy / Q000009:adverse effects / Q000401:mortality