Primary early thoracoscopy and reduction in length of hospital stay and additional procedures among children with complicated pneumonia: results of a multicenter retrospective cohort study.

OBJECTIVE: To determine the effect of initial procedure type on the length of hospital stay (LOS) and on the requirement for additional pleural fluid drainage procedures in a large multicenter cohort of children with pneumonia complicated by pleural effusion.

DESIGN: Retrospective cohort study.

SETTING: Administrative database containing inpatient resource use data from 27 tertiary care children's hospitals.

PARTICIPANTS: Patients between 12 months and 18 years of age diagnosed as having complicated pneumonia were eligible for the study if they were discharged from the hospital between January 1, 2001, and December 31, 2005, and underwent early (within 2 days of the index hospitalization) pleural fluid drainage.

INTERVENTION: Pleural fluid drainage, categorized as chest tube placement, video-assisted thoracoscopic surgery (VATS), or thoracotomy.

MAIN OUTCOME MEASURES: The LOS and the requirement for additional pleural fluid drainage.

RESULTS: Nine hundred sixty-one of 2862 patients (33.6%) with complicated pneumonia underwent early pleural fluid drainage. Initial procedures included chest tube placement (n = 714), VATS (n = 50), and thoracotomy (n = 197). The median patient age was 4.0 years (interquartile range, 2.0-8.0 years). The median LOS was 10 days (interquartile range, 7-14 days). Two hundred ninety-eight patients (31.0%) required at least 1 additional pleural fluid drainage procedure, and 44 patients (4.6%) required more than 2 pleural fluid drainage procedures. In linear regression analysis, children undergoing primary VATS had a 24% (adjusted beta coefficient, -0.24; 95% confidence interval, -0.41 to -0.07) shorter LOS than patients undergoing primary chest tube placement; this translated into a 2.8-day reduction in the LOS for those undergoing early primary VATS. In logistic regression analysis, patients undergoing primary VATS had an 84% (adjusted odds ratio, 0.16; 95% confidence interval, 0.06-0.42) reduction in the requirement for additional pleural fluid drainage procedures compared with patients undergoing primary chest tube placement.

CONCLUSION: Our large retrospective multicenter study demonstrates that, compared with primary chest tube placement, primary VATS is associated with shorter LOS and fewer additional procedural interventions.