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Relative to primary chest tube placement, video-assisted thoracoscopic surgery reduces hospital LOS, subsequent drainage procedures in children with complicated pneumonia

Wednesday, August 13 2008 | Comments

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What's This? Initial pleural fluid drainage by way of video-assisted thoracoscopic surgery (VATS) rather than primary chest tube placement is associated with a shorter length of hospital stay (LOS) and fewer additional procedural interventions in children with complicated pneumonia, a retrospective cohort study found.

Investigators analyzed discharge information from 27 children's hospitals in the Pediatric Health Information System database. From 2001 through 2005, 961 children aged 12 months to 18 years with complicated pneumonia underwent pleural fluid drainage within 2 days of hospitalization. Pleural drainage procedures could be thoracostomy tube placement, VATS, or thoracotomy. Nearly 15% of patients with asthma also received systemic corticosteroids.

The dependent variables were LOS and the need for an additional pleural fluid drainage procedure during the same hospitalization.

The types of primary procedures performed, the median LOS, and the requirement for additional drainage procedures varied considerably across hospitals.

"This heterogeneity in initial management likely reflects the lack of appropriately designed studies and evidence-based guidelines addressing this topic," the study authors noted.

Overall, the median LOS was 10 days, and 298 patients (31%) required at least 1 additional drainage procedure. Furthermore, 44 patients needed 3 further drainage procedures and 19 required 4 or more.

In a multivariable analysis that adjusted for asthma diagnosis and receipt of systemic corticosteroids and empirical vancomycin, the LOS was 24% less (95% CI, 7%-41%), or 2.8 days shorter, in patients who received primary VATS rather than primary chest tube placement. Controlling for the same variables in logistic regression analysis, initial VATS was also associated with an 84% reduction in the need for additional drainage when compared with primary chest tube placement (adjusted OR, 0.16; 95% CI, 0.06-0.42).

Additionally, children who were white had shorter LOSs than those who were other races/ethnicities, even after controlling for procedure type and clustering by hospital.

"Although these immediate short-term outcomes are important considerations, longitudinal studies of long-term functional outcomes of patients undergoing different initial drainage procedures are necessary to help determine the optimal management strategies," the researchers concluded. (Shah S, et al. Arch Pediatr Adolesc Med 2008;162:675-681.)

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