Abstract
Background: The ideal surgical approach for empyema in children (≤18 years) remains controversial. Video assisted thoracoscopic surgery (VATS) and chest drain with fibrinolysis (CDF) are both accepted methods. The aim of this study was to clarify which of these two techniques provides the best clinical outcome. Methods: A systematic review and meta-analysis (1997–2018) was conducted. We used the random-effect model to produce risk ratio (RR) for categorical variables, and standard difference in means (SDM) for continuous variables, along with 95% confidence intervals [CI]. I 2 value was used to assess heterogeneity. P values <0.05 were considered significant. Results: We identified 707 studies: 10 studies were included in the final analysis. The incidence of total peri-operative complications was not different between the two groups (RR 0.6 [CI: 0.3–1.2], p = 0.2; I 2 = 0.0%; p = 0.6). Need for re-intervention was significantly lower in the VATS group (RR 0.55 [CI: 0.34–0.88], p = 0.01; I 2 = 14.4%; p = 0.3). Post-operative length of hospital stay was significantly shorter in the VATS group (SDM −0.45 [CI: −0.78 to −0.12], p = 0.007; I 2 = 88%; p = 0.001). Conclusions: Current evidence suggests that VATS and CDF for empyema in children have a similar incidence of peri-operative complications. However, VATS seems associated with reduced need for re-intervention and shorter post-operative hospital stay.
| Original language | English |
|---|---|
| Pages (from-to) | 42-48 |
| Number of pages | 7 |
| Journal | Paediatric Respiratory Reviews |
| Volume | 30 |
| DOIs | |
| Publication status | Published - Apr 2019 |
Keywords
- Children
- Empyema
- Fibrinolysis
- VATS
Cite this
}
Management of paediatric empyema by video-assisted thoracoscopic surgery (VATS) versus chest drain with fibrinolysis : Systematic review and meta-analysis. / Pacilli, Maurizio; Nataraja, Ramesh Mark.
In: Paediatric Respiratory Reviews, Vol. 30, 04.2019, p. 42-48.Research output: Contribution to journal › Review Article › Research › peer-review
TY - JOUR
T1 - Management of paediatric empyema by video-assisted thoracoscopic surgery (VATS) versus chest drain with fibrinolysis
T2 - Systematic review and meta-analysis
AU - Pacilli, Maurizio
AU - Nataraja, Ramesh Mark
PY - 2019/4
Y1 - 2019/4
N2 - Background: The ideal surgical approach for empyema in children (≤18 years) remains controversial. Video assisted thoracoscopic surgery (VATS) and chest drain with fibrinolysis (CDF) are both accepted methods. The aim of this study was to clarify which of these two techniques provides the best clinical outcome. Methods: A systematic review and meta-analysis (1997–2018) was conducted. We used the random-effect model to produce risk ratio (RR) for categorical variables, and standard difference in means (SDM) for continuous variables, along with 95% confidence intervals [CI]. I 2 value was used to assess heterogeneity. P values <0.05 were considered significant. Results: We identified 707 studies: 10 studies were included in the final analysis. The incidence of total peri-operative complications was not different between the two groups (RR 0.6 [CI: 0.3–1.2], p = 0.2; I 2 = 0.0%; p = 0.6). Need for re-intervention was significantly lower in the VATS group (RR 0.55 [CI: 0.34–0.88], p = 0.01; I 2 = 14.4%; p = 0.3). Post-operative length of hospital stay was significantly shorter in the VATS group (SDM −0.45 [CI: −0.78 to −0.12], p = 0.007; I 2 = 88%; p = 0.001). Conclusions: Current evidence suggests that VATS and CDF for empyema in children have a similar incidence of peri-operative complications. However, VATS seems associated with reduced need for re-intervention and shorter post-operative hospital stay.
AB - Background: The ideal surgical approach for empyema in children (≤18 years) remains controversial. Video assisted thoracoscopic surgery (VATS) and chest drain with fibrinolysis (CDF) are both accepted methods. The aim of this study was to clarify which of these two techniques provides the best clinical outcome. Methods: A systematic review and meta-analysis (1997–2018) was conducted. We used the random-effect model to produce risk ratio (RR) for categorical variables, and standard difference in means (SDM) for continuous variables, along with 95% confidence intervals [CI]. I 2 value was used to assess heterogeneity. P values <0.05 were considered significant. Results: We identified 707 studies: 10 studies were included in the final analysis. The incidence of total peri-operative complications was not different between the two groups (RR 0.6 [CI: 0.3–1.2], p = 0.2; I 2 = 0.0%; p = 0.6). Need for re-intervention was significantly lower in the VATS group (RR 0.55 [CI: 0.34–0.88], p = 0.01; I 2 = 14.4%; p = 0.3). Post-operative length of hospital stay was significantly shorter in the VATS group (SDM −0.45 [CI: −0.78 to −0.12], p = 0.007; I 2 = 88%; p = 0.001). Conclusions: Current evidence suggests that VATS and CDF for empyema in children have a similar incidence of peri-operative complications. However, VATS seems associated with reduced need for re-intervention and shorter post-operative hospital stay.
KW - Children
KW - Empyema
KW - Fibrinolysis
KW - VATS
UR - http://www.scopus.com/inward/record.url?scp=85065925130&partnerID=8YFLogxK
U2 - 10.1016/j.prrv.2018.09.001
DO - 10.1016/j.prrv.2018.09.001
M3 - Review Article
VL - 30
SP - 42
EP - 48
JO - Paediatric Respiratory Reviews
JF - Paediatric Respiratory Reviews
SN - 1526-0542
ER -