Denise M Garofalo, Michael R Bronsert, Christina M Stuart, Adam R Dyas, Paul D Rozeboom, Lauren T Gallagher, Quintin W O Myers, Michael K Dalton, Ariel Wolf, Samuel Mathai, Joanna Etra, William Marshall, Juan-Pablo Idrovo, Whitney Jenson, Franklin Wright, Michael Cripps, Clay C Burlew, Robert A Meguid, Catherine G Velopulos
This study adds to ongoing debate regarding the optimal timing of VATS for retained hemothorax, supporting the need for prospective study.
INTRODUCTION: Video-assisted thoracic surgery (VATS) is recommended for approximately 30% of hemothoraces that become retained, yet the optimal timing for VATS remains debated. We sought to compare the relationship between VATS timing and associated outcomes.
METHODS: The pulmonary morbidity and mortality of early (≤4d), intermediate (5-10d) and late (≥10d) VATS in adults were compared in the 2017-2021 Trauma Quality Improvement Program.
RESULTS: Of the 9784 VATS identified, pulmonary morbidity (57%) and mortality (4.5%) were higher in the early group relative to the intermediate (41, 3.0%) and late groups (48, 2.9%, p < 0.01) with higher rates of reintervention including secondary thoracotomy (4.5 vs. 3.1 vs. 3.2% p = 0.04) and tube thoracostomy (51 vs. 24 vs. 24%, p < 0.01). Risk-adjusted rates of both outcomes were inversely proportional to VATS days (p < 0.01).
CONCLUSION: This study adds to ongoing debate regarding the optimal timing of VATS for retained hemothorax, supporting the need for prospective study.