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Tracking the outcomes of surgical treatment of Stage 2 and 3 empyema: introduction and consolidation of minimally invasive approach
Author(s) -
Patella Miriam,
Minerva Eleonora Maddalena,
Porcellini Iride,
Cianfarani Agnese,
Tessitore Adele,
Cafarotti Stefano
Publication year - 2021
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.17133
Subject(s) - medicine , interquartile range , empyema , video assisted thoracoscopic surgery , thoracotomy , chest tube , surgery , thoracoscopy , fast track , pneumothorax
Background We described the results of surgical treatment of empyema, tracing outcomes throughout the passage from the open thoracotomy (OT) approach to video‐assisted thoracoscopic surgery (VATS) in a single institute. Methods We retrospectively analyzed the records of 88 consecutive patients treated for Stage 2 and 3 empyema (2010–2019). We divided the study period into three groups: OT period (2010–2013), early VATS (2014–2017, from the introduction of VATS program, until acme of learning curve), and late VATS (2018–2019). Groups were compared to investigate the outcomes evolution. Results Most relevant findings of the study were significant variation in postoperative length of stay (median [interquartile range]: 9 days [7.5–10], 10 [7.5–17.5], and 7 [5–10] for OT period, early VATS, and late VATS, respectively, p = 0.005), hospital admission referral to thoracic surgery interval (7.5 days [4.5–11], 6.5 [3–9], and 2.5 [1.5–5.5], p = 0.003), chest tube duration (5.5 days [5–7.5], 6 [4–6], 4 [3–5], p = 0.003), and proportion of operation performed by residents (3 [15%], 6 [16.7%], 14 [43.6%], p = 0.01). Conclusions Our findings pictured the trajectory evolution of outcomes during introduction and consolidation of VATS treatment of empyema. During the early phase, we observed a decline in some indicators that improved significantly in the late VATS period. After a learning curve, all outcomes showed better results and we entered into a teaching phase.