Optimal timing of video-assisted thoracoscopic surgery for primary spontaneous pneumothorax in children.
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 12-21years 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 16.1years (+/- 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 6days (IQR 4-7) and was longer in patients who underwent VATS (p
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 48h of management should prompt earlier surgical intervention.
TYPE OF STUDY: Retrospective.
LEVEL OF EVIDENCE: III.
Journal of pediatric surgery
Child; Adolescent; Human; Thoracic Surgery, Video-Assisted; Pneumothorax, Primary Spontaneous; Time-to-Treatment
Pediatric; Spontaneous pneumothorax; Thoracoscopic surgery; Video-assisted
Williams, K., Lautz, T. B., Leon, A. H., Oyetunji, T. A. Optimal timing of video-assisted thoracoscopic surgery for primary spontaneous pneumothorax in children. Journal of pediatric surgery 53, 1858-1861 (2018).