Joseph Balaban1, Lorrie Burkhalter2, Diana L Diesen3. 1UT Southwestern, Dallas, Tx, 2Children’s Health Dallas, 3UT Southwestern, Department of Surgery; Children’s Health Dallas
Introduction: Traditionally, Video Assisted Thorascopic Surgery (VATS) decortication has been the gold standard treatment for pediatric empyema. Recent studies have shown that fibrinolytics via tube thoracostomy produced similar outcomes while being less invasive and more cost-effective. Clinical practice started to change though difference in efficacy, hospital stay, cost, and failure rate are still debated.
Methods: We performed an IRB approved retrospective review of 161 otherwise healthy patients seen at a pediatric hospital from 2007 -2017 with a primary diagnosis of empyema treated with either fibrinolytics via chest tube or VATS decortication. Children were excluded if they had complex medical comorbidities or secondary empyema. This time period included our transition from first-line VATS treatment to fibrinolytic treatment.
Patient demographics, clinical and outcomes data points were collected. Age, size of effusion, necrotizing pneumonia, loculations, and mediastinal shift were specifically examined to determine if these subgroups had improved outcome with either VATS or fibrinolytics.
Results: There were 161 otherwise healthy pediatric patients treated for empyema between 2007-2017 with 95 patients treated with fibrinolytics and 66 treated with VATS. There were no differences seen in age, gender, race, ethnicity, weight, days of symptoms, asthma history, previous pneumonia, or WBC. Those patients in the fibrinolytic group did have more oxygen requirement on presentation and the fibrinolytic group were more likely to have loculated effusions (p<0.05).
The two groups (fibrinolytics vs VATS) had similar outcomes when it came to days of oxygen support, days of antibiotics, days of narcotic use, days until fever resolved, number of chest tubes, days intubated, LOS, and readmission rate The fibrinolytic group has slightly longer ICU days (3 vs 1.4) and received higher number of US but the same numbers of CT scans (0.5 vs 0.4) p<0.05.
There was an 5.3% (5/95) failure rate in fibrinolytic patients and 7.6% in the VATS group (5/66) defined as needing repeat procedure (CT placement).
In the subgroup of children> 5, patients treated with VATS had shorter hospital LOS, ICU LOS, days of narcotics, and no treatment failures. Neither size of effusion, presence of necrotizing pneumonia, loculated effusion, nor mediastinal shift subgrouping correlated with improved outcome with one type of treatment.
Conclusion: Both VATS and fibrinolytic treat pediatric empyema in otherwise healthy children with fibrinolytic therapy offering a less invasive alternative. Further research is needed to determine if there are benefits of one approach over another for subpopulations of patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95616
Program Number: P641
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster