title: Making the transition from video-assisted thoracoscopic surgery to chest tube with fibrinolytics for empyema in children: Any change in outcomes?
abstract: BACKGROUND
  There is ongoing variation in the use of video-assisted thoracoscopic surgery (VATS) and chest tube with fibrinolytics (CTWF) for empyema in children. Our objective was to report outcomes from a centre that recently made the transition from VATS to CTWF as the primary treatment modality.
  
  
  METHODS
  We conducted a historical cohort study of children with empyema treated with either primary VATS (between 2005 and 2009) or CTWF (between 2009 and 2013).
  
  
  RESULTS
  Sixty-seven children underwent pleural drainage for empyema during the study period: 28 (42%) were treated with primary VATS, and 39 (58%) underwent CTWF. There were no significant differences between the VATS and CTWF groups for length of stay (8 v. 9 d, p = 0.61) or need for additional procedures (4% v. 13%, p = 0.19). Length of stay varied widely for both VATS (4-53 d) and CTWF (5-46 d). Primary VATS failed in 1 (4%) patient, who required an additional chest tube, and CTWF failed in 5 (13%) patients. Additional procedures included 3 rescue VATS, 2 additional chest tubes and 1 thoracotomy. All patients recovered and were discharged home.
  
  
  CONCLUSIONS
  Primary VATS and CTWF were associated with similar outcomes in children with empyema. There appears to be a subset of children at risk for treatment failure with CTWF. Further research is needed to determine if these patients would benefit from primary VATS.
authors.affiliation: From the Division of General Surgery, Western University (Livingston, Vogt, Merritt, Bütter); the Schulich School of Medicine & Dentistry, Western University (Colozza); and the Division of Pediatric Surgery, Western University (Merritt, Bütter), London, Ont.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Livingston
authors.affiliation: From the Division of General Surgery, Western University (Livingston, Vogt, Merritt, Bütter); the Schulich School of Medicine & Dentistry, Western University (Colozza); and the Division of Pediatric Surgery, Western University (Merritt, Bütter), London, Ont.
authors.forename: Sara
authors.initials: S
authors.lastname: Colozza
authors.affiliation: From the Division of General Surgery, Western University (Livingston, Vogt, Merritt, Bütter); the Schulich School of Medicine & Dentistry, Western University (Colozza); and the Division of Pediatric Surgery, Western University (Merritt, Bütter), London, Ont.
authors.forename: Kelly N
authors.initials: KN
authors.lastname: Vogt
authors.affiliation: From the Division of General Surgery, Western University (Livingston, Vogt, Merritt, Bütter); the Schulich School of Medicine & Dentistry, Western University (Colozza); and the Division of Pediatric Surgery, Western University (Merritt, Bütter), London, Ont.
authors.forename: Neil
authors.initials: N
authors.lastname: Merritt
authors.affiliation: From the Division of General Surgery, Western University (Livingston, Vogt, Merritt, Bütter); the Schulich School of Medicine & Dentistry, Western University (Colozza); and the Division of Pediatric Surgery, Western University (Merritt, Bütter), London, Ont.
authors.forename: Andreana
authors.initials: A
authors.lastname: Bütter
mesh_terms: D000293:Adolescent; D015505:Chest Tubes / Q000009:adverse effects / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004322:Drainage / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D016724:Empyema, Pleural / Q000601:surgery*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D007223:Infant; D007263:Infusions, Parenteral; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data
chemical_list: D005343:Fibrinolytic Agents