A comparison of video-assisted thoracoscopic surgery with open thoracotomy for the management of chest trauma: a systematic review and meta-analysis.

BACKGROUND: This study aimed to systematically review and compare the perioperative outcomes of video-assisted thoracoscopy (VATS) with open thoracotomy for chest trauma patients.
METHODS: We conducted a systematic review and meta-analysis of randomized control trials and cohort studies comparing the perioperative outcomes of VATS with open thoracotomy for chest trauma patients. Clinical endpoints included postoperative complications, perioperative mortality rate, chest tube drainage volume, duration of tube drainage, duration of hospitalization, operation time, and amount of bleeding and transfusion volume in operation. A subgroup analysis was performed to explore the potential source of heterogeneity.
RESULTS: Twenty-six studies were included. Pooled analyses showed significant reductions in the incidence of postoperative complications (risk ratio [RR] [95% confidence interval (CI)], 0.47 [0.35, 0.64]), chest tube drainage volume (mean difference [MD] [95% CI], -146.88 ml [-196.04, -97.72]), duration of tube drainage (MD, -1.71 days; 95% CI -2.16 to -1.26), duration of hospitalization (MD, -4.67 days; 95% CI -5.19 to-4.14), operation time (MD, -41.18 min; 95% CI -52.85 to -29.51), and amount of bleeding (MD, -119.10 ml; 95% CI -147.28 to -90.92) and transfusion volume (MD, -379.51 ml; 95% CI -521.24 to-237.77) in chest trauma patients treated with VATS compared with open thoracotomy. The perioperative mortality rate was not significantly different between patients received VATS and open thoracotomy (RR, 0.52; 95% CI 0.22-1.21).
CONCLUSIONS: Compared to open thoracotomy, VATS is an effective and even better treatment for improving perioperative outcomes of hemodynamically stable patients with chest trauma and reduce the complications. However, caution should also be exercised in certain clinical scenarios.