Behrad Ziapour1, Elmira Mostafidi2, Homayoun Sadeghi-Bazargani3,4, Ali Kabir5, Ikenna Okereke6. 1. Tufts Medical Center, 800 Washington Street #1035, Boston, MA, 02111, USA. behradzpr@gmail.com. 2. Tabriz University of Medical Sciences, Tabriz, Iran. 3. Department of Statistics and Epidemiology, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran. 4. Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden. 5. Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran. 6. Chief of Thoracic Surgery, Division of Cardiovascular and Thoracic Surgery, Program Director, Cardiothoracic Fellowship Program, Division of Cardiothoracic Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-0528, USA.
Abstract
PURPOSE: In this systematic review, we analyzed the optimal time range to evacuate traumatic-retained hemothorax using video-assisted thoracoscopic surgery (VATS). METHODS: We searched PubMed, EMBASE, the Cochrane Register of Controlled Trials, Google Scholar, and the U.S. National Library of Medicine clinical trials database up to February 2019. Randomized controlled trials (RCTs) and observational studies with relevant data were included. Data were extracted from studies that reported the success, mortality, or length of hospital stay (LOS) after using VATS during at least two out of three of our time-ranges of interest: days 1-3 (group A), days 4-6 (group B), and day 7 or later (group C). RESULTS: Six cohort studies with 476 total participants were included in the meta-analysis. The patients in group A had a significantly higher success rate than those in group C (RR = 0.42; 95% CI = 0.21-0.84, p = 0.01). The total LOS for patients whose retained hemothorax was evacuated in group A was 4.7 days shorter than that for those in group B (95% CI = - 5.6 to - 3.8, p = 0.006). Likewise, group B patients were discharged 18.1 days earlier than group C patients (95% CI = - 22.3 to - 14, p < 0.001). Short-term mortality was not decreased by early VATS. CONCLUSIONS: Our results indicate that VATS should be considered within the first three days of admission if this intervention is the clinician's choice to evacuate a traumatic-retained hemothorax. Protocol registration number in PROSPERO: CRD42017046856.
PURPOSE: In this systematic review, we analyzed the optimal time range to evacuate traumatic-retained hemothorax using video-assisted thoracoscopic surgery (VATS). METHODS: We searched PubMed, EMBASE, the Cochrane Register of Controlled Trials, Google Scholar, and the U.S. National Library of Medicine clinical trials database up to February 2019. Randomized controlled trials (RCTs) and observational studies with relevant data were included. Data were extracted from studies that reported the success, mortality, or length of hospital stay (LOS) after using VATS during at least two out of three of our time-ranges of interest: days 1-3 (group A), days 4-6 (group B), and day 7 or later (group C). RESULTS: Six cohort studies with 476 total participants were included in the meta-analysis. The patients in group A had a significantly higher success rate than those in group C (RR = 0.42; 95% CI = 0.21-0.84, p = 0.01). The total LOS for patients whose retained hemothorax was evacuated in group A was 4.7 days shorter than that for those in group B (95% CI = - 5.6 to - 3.8, p = 0.006). Likewise, group B patients were discharged 18.1 days earlier than group C patients (95% CI = - 22.3 to - 14, p < 0.001). Short-term mortality was not decreased by early VATS. CONCLUSIONS: Our results indicate that VATS should be considered within the first three days of admission if this intervention is the clinician's choice to evacuate a traumatic-retained hemothorax. Protocol registration number in PROSPERO: CRD42017046856.
Entities:
Keywords:
Hemothorax; Retained hemothorax; Thoracic injuries; Video-assisted thoracoscopic surgery
Authors: Susan L Norris; David Atkins; Wendy Bruening; Steven Fox; Eric Johnson; Robert Kane; Sally C Morton; Mark Oremus; Maria Ospina; Gurvaneet Randhawa; Karen Schoelles; Paul Shekelle; Meera Viswanathan Journal: J Clin Epidemiol Date: 2011-06-01 Impact factor: 6.437