TY - JOUR
T1 - Optimal timing of video-assisted thoracoscopic surgery for primary spontaneous pneumothorax in children
AU - Williams, Kibileri
AU - Lautz, Timothy B.
AU - Leon, Astrid H.
AU - Oyetunji, Tolulope A.
PY - 2018/9
Y1 - 2018/9
N2 - Purpose: There is no consensus in the pediatric surgical community about when to recommend video-assisted thoracoscopic surgery (VATS) for patients with primary spontaneous pneumothorax (PSP). We aimed to identify factors that predict the likelihood of requiring VATS, and to compare recurrence rates and healthcare utilization among different management approaches to PSP. Methods: A retrospective chart review and a telephone survey were conducted on all patients 12–21 years who were diagnosed with PSP from 2007 to 2015. Data were extracted on patient demographics, initial management, hospital length of stay (LOS), and subsequent admissions, procedures, and recurrences. Results: A total of 46 patients were included with a mean age of 16.1 years (+/− 1.2). Most patients were male (41, 89%) and white (16, 44%). Initial management comprised chest tube drainage alone in 28 (61%), no intervention in 8 (17%), and VATS in 10 (22%). Total LOS was 6 days (IQR 4–7) and was longer in patients who underwent VATS (p < 0.001). Recurrence occurred in 17 patients (37%). However, recurrence and healthcare utilization were not significantly associated with initial management approach. Among those who had initial chest tube drainage, 14 (50%) underwent VATS on that admission, and 8 (28%) had subsequent surgery. Significant predictors of ultimately requiring VATS were presence of an air leak and partial lung expansion. Conclusion: Most patients with PSP currently undergo chest tube placement as initial management, although most eventually require VATS. Presence of an air leak and partial lung expansion on chest radiograph within the first 48 h of management should prompt earlier surgical intervention. Type of study: Retrospective. Level of evidence: III
AB - Purpose: There is no consensus in the pediatric surgical community about when to recommend video-assisted thoracoscopic surgery (VATS) for patients with primary spontaneous pneumothorax (PSP). We aimed to identify factors that predict the likelihood of requiring VATS, and to compare recurrence rates and healthcare utilization among different management approaches to PSP. Methods: A retrospective chart review and a telephone survey were conducted on all patients 12–21 years who were diagnosed with PSP from 2007 to 2015. Data were extracted on patient demographics, initial management, hospital length of stay (LOS), and subsequent admissions, procedures, and recurrences. Results: A total of 46 patients were included with a mean age of 16.1 years (+/− 1.2). Most patients were male (41, 89%) and white (16, 44%). Initial management comprised chest tube drainage alone in 28 (61%), no intervention in 8 (17%), and VATS in 10 (22%). Total LOS was 6 days (IQR 4–7) and was longer in patients who underwent VATS (p < 0.001). Recurrence occurred in 17 patients (37%). However, recurrence and healthcare utilization were not significantly associated with initial management approach. Among those who had initial chest tube drainage, 14 (50%) underwent VATS on that admission, and 8 (28%) had subsequent surgery. Significant predictors of ultimately requiring VATS were presence of an air leak and partial lung expansion. Conclusion: Most patients with PSP currently undergo chest tube placement as initial management, although most eventually require VATS. Presence of an air leak and partial lung expansion on chest radiograph within the first 48 h of management should prompt earlier surgical intervention. Type of study: Retrospective. Level of evidence: III
KW - Pediatric
KW - Spontaneous pneumothorax
KW - Thoracoscopic surgery
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U2 - 10.1016/j.jpedsurg.2017.11.047
DO - 10.1016/j.jpedsurg.2017.11.047
M3 - Article
C2 - 29277465
AN - SCOPUS:85039555434
VL - 53
SP - 1858
EP - 1861
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
SN - 0022-3468
IS - 9
ER -