For patients with empyema, does video-assisted thorascopic surgery achieve better outcomes than chest tube drainage?

Bottom line:  Video-assisted thorascopic surgery (VATS) may reduce length of stay compared to chest tube drainage.

SummaryParapneumonic 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Systematic review withdrawn because authors did not have resources to update.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).


About Amy

Clinical Informationist at EUH Branch Library
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