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International Society For Minimally Invasive Cardiothoracic Surgery

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Uniportal Video-assisted Thoracic Surgery Decortication For Treatment Of Empyema: The Earlier The Better?
Stevan Pupovac, Paul C. Lee, David Zeltsman.
Northwell Health at Hofstra School of Medicine, Queens, NY, USA.

Background: 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 uniportal VATS decortication for ‘early-intervention' and ‘late-intervention,' for stage empyema.
Methods: Over a five-year period, 52 consecutive patients underwent uniportal 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 uniportal VATS decortication for empyema is feasible, and expeditious surgical intervention is recommended from the timing of initial diagnosis.
LEGEND: Figure 1. Length of stay following uniportal video-assisted thoracic surgery (VATS) decortication for empyema, by patient group.


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