Outcomes of paediatric empyema with lung abscess treated by video-assisted thoracoscopic surgery (VATS): a retrospective cohort study.

PURPOSE: The incidence of paediatric pleural empyema is increasing globally. In adult populations, the presence of concurrent lung abscess with pleural empyema has been reported with worse outcomes. However, in the paediatric population no evidence currently exists demonstrating the role of lung abscess in determining short term outcomes. METHODS: A 20-year retrospective review was conducted in a tertiary institution, in all children between 0 and 16 years with empyema who underwent VATS decortication. Patients managed non-operatively or with initial thoracotomy were excluded. Data collected included demographics, clinical presentation information and laboratory results. The primary outcome was chest tube duration; secondary outcomes included hospital LOS, conversion to thoracotomy, repeat operation, ICU LOS, and nurse- or patient-controlled analgesia duration. RESULTS: A total of 153 paediatric patients were included, with 25 (16.3%) having concurrent lung abscess. Patients with lung abscess had a significantly longer chest tube duration (median 9 vs. 5 days, p < 0.0001) and length of stay (median 14 vs. 10 days, p = 0.0001). Repeat operation was more frequent among patients with lung abscess than among those without (12.0% versus 1.6%, p = 0.0311). CONCLUSION: In children undergoing VATS for pleural empyema, concurrent lung abscess was associated with poorer short-term outcomes. Further prospective research using standardised diagnostic criteria is required. LEVEL OF EVIDENCE: Level IV.