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Eastern Cardiothoracic Surgical Society

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Single-Incision Video-Assisted Thoracic Surgery Decortication for Treatment of Empyema: the Earlier the Better?
Stevan S. Pupovac, Paul C. Lee, David Zeltsman
Northwell Health, Queens, NY, USA

OBJECTIVE: Recent years have seen a trend towards utilizing a video-assisted thoracic surgery (VATS) approach for treatment of empyema. Given that empyema mandates intervention, limited attention has been paid to any potential impact of the time interval from diagnosis to the intervention itself. We sought to evaluate the feasibility and outcomes of single-incision VATS decortication for ‘early-intervention’ and ‘late-intervention,’ for stage empyema.
METHODS: Over a five-year period, 52 consecutive patients underwent single-incision VATS decortication for empyema. Based upon the time interval between diagnosis and the time of the procedure, patients were divided into 2 groups: ‘early-intervention’ (Group 1, 0-3 days from time of diagnosis, n = 28), vs. ‘late-intervention’ (Group 2, ≥4 days from time of diagnosis, n = 24). Intraoperative data and short-term clinical outcomes were analyzed in 52 patients.
RESULTS: Baseline demographics did not differ between groups. Average length of stay following decortication for the ‘early-intervention’ group was significantly shorter compared to the ‘late-intervention’ group (7.55 ± 5.39 vs 11.09 ± 5.82, p = 0.03). There were no conversions to open surgery. Major perioperative complications were also comparable between groups, including stroke, reoperation for bleeding, sepsis of any cause, surgical site infection, new renal failure, and myocardial infarction. There were no differences between groups with regards to location of discharge (home vs rehab).
CONCLUSIONS: Our findings suggest that single-incision VATS decortication for empyema is feasible, and expeditious surgical intervention is recommended from the timing of initial diagnosis.


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