Post-operative outcome of paediatric empyema treated with video assisted thoracoscopic surgery (VATS).

Background and Aims: VATS is commonly performed in children with empyema, however, there is no data regarding the post-operative outcomes (after discharge) following the procedure. Method(s): A 5-year (2013-2018) retrospective review was performed on children treated with VATS and chest drain for empyema. The study was approved by the local ethics committee (RES-18-0000-071Q). Statistics: results are reported as number of cases (%) and median (range). Correlation and logistic regression analysis were performed. Result(s): We identified 62 children, 36 (58%) males, with a median age of 3.6 (0.4-14.5) years treated over the 5-year period. Presentation was: autumn 12 (19%), winter 19 (31%), spring 19 (31%) and summer 12 (19%) patients. Median post-operative follow-up was 47 (9-489) days. Streptococcus species were identified in 35 (56%) of cultures from pleural fluid. Chest drain was left in situ for a median of 4 (2-13) days. Four (6%) children required a second procedure (3 VATS, 1 thoracotomy). Median duration of pre-operative symptoms before the VATS procedure was 9 (4-17) days. Median post-operative length of stay was 8 (3-28) days and duration of oral antibiotics therapy after discharge was 28 (3-42) days. Thirty-nine (63%) required post-operative oxygen therapy for 3 (1-16) days. There was no correlation between the duration of pre-operative symptoms at the time of VATS and post-operative length of stay (r = -.03 [95% CI-0.3-0.2]; P = 0.7] (Figure) Post-operative x-ray was available for 56 (90%) patients and documented persisting lung or pleural abnormalities in 47 (84%). Logistic regression analysis failed to identify any predisposing factors for persisting x-ray abnormalities (P = 0.63). Conclusion(s): We found a significant incidence of persisting abnormalities on post-operative x-ray following VATS with chest drain for empyema in children. Long-term follow-up of children following VATS might be indicated to identify patients at risk of chronic respiratory pr