Increased pulmonary morbidity and mortality with early video-assisted thoracic surgery for retained hemothorax.

INTRODUCTION

Video-assisted thoracic surgery (VATS) is recommended for approximately 30% of hemothoraces that become retained, yet the optimal timing for VATS remains debated. We sought to compare the relationship between VATS timing and associated outcomes.

METHODS

The pulmonary morbidity and mortality of early (≤4d), intermediate (5-10d) and late (≥10d) VATS in adults were compared in the 2017-2021 Trauma Quality Improvement Program.

RESULTS

Of the 9784 VATS identified, pulmonary morbidity (57%) and mortality (4.5%) were higher in the early group relative to the intermediate (41, 3.0%) and late groups (48, 2.9%, p < 0.01) with higher rates of reintervention including secondary thoracotomy (4.5 vs. 3.1 vs. 3.2% p = 0.04) and tube thoracostomy (51 vs. 24 vs. 24%, p < 0.01). Risk-adjusted rates of both outcomes were inversely proportional to VATS days (p < 0.01).

CONCLUSION

This study adds to ongoing debate regarding the optimal timing of VATS for retained hemothorax, supporting the need for prospective study.