Bottom line: Video-assisted thorascopic surgery (VATS) may reduce length of stay compared to chest tube drainage.
Summary: Parapneumonic effusion and empyema in adults summary in DynaMed.
References an RCT and a Cochrane review.
Bilgin M, et al. Benefits of early aggressive management of empyema thoracis. ANZ J Surg 2006 Mar;76(3):120
Unblinded trial of 70 adults with empyema randomized to VATS vs. tube thoracostomy without video assistance. RESULTS: ◦comparing VATS vs. tube thoracostomy■subsequent open surgical procedure in 17.1% (VATS) vs. 37.1% (chest tube) (p < 0.05, NNT 5); mean hospital stay 8.3 days (VATS) vs. 12.8 days (chest tube) (p < 0.05)
Coote N, et al. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD001956.
Systematic review withdrawn because authors did not have resources to update. Original review published in 2005. RESULTS: Identified one small RCT with methodological limitations (unclear patient selection, blinding methods.) 20 patients with empyema randomized to VATS or chest tube drainage plus fibrinolytic therapy. RESULTS: Chest tube duration 5.8 +/-1.1 (VATS) vs 9.8 +/-1.3 days (chest tube) (p=0.03); length of stay (8.7 +/-0.9 (VATS) vs 12.8 +/-1.1 days (chest tube) (p=0.00).