Early evacuation of traumatic retained hemothoraces using thoracoscopy: A prospective, randomized trial

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1396-1401
Number of pages6
JournalAnnals of Thoracic Surgery
Volume64
Issue number5
DOIs
StatePublished - Nov 1997

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Hemothorax
Thoracoscopy
Drainage
Length of Stay
Thoracotomy
Hospital Costs
Hospitalization
Thoracostomy
Empyema
Wounds and Injuries
Group Psychotherapy
Costs and Cost Analysis
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

@article{75a8d45dd89b4af4870e83e1e2e768df,
title = "Early evacuation of traumatic retained hemothoraces using thoracoscopy: A prospective, randomized trial",
abstract = "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.",
author = "Meyer, {Dan M} and Jessen, {Michael E} and Wait, {Michael A} and Estrera, {Aaron S.}",
year = "1997",
month = "11",
doi = "10.1016/S0003-4975(97)00899-0",
language = "English (US)",
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pages = "1396--1401",
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TY - JOUR

T1 - Early evacuation of traumatic retained hemothoraces using thoracoscopy

T2 - A prospective, randomized trial

AU - Meyer, Dan M

AU - Jessen, Michael E

AU - Wait, Michael A

AU - Estrera, Aaron S.

PY - 1997/11

Y1 - 1997/11

N2 - 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.

AB - 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.

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