Primary operative management for pediatric empyema: decreases in hospital length of stay and charges in a national sample

Arch Pediatr Adolesc Med. 2008 Jan;162(1):44-8. doi: 10.1001/archpediatrics.2007.10.


Objective: To determine whether primary operative management (decortication within the first 2 days of hospitalization) decreases hospital length of stay (LOS) and total charges in children with empyema.

Design: Retrospective cohort study.

Setting: Nationally representative Kids' Inpatient Database for 2003.

Participants: Children and adolescents aged 0 to 18 years (hereinafter referred to as children) with empyema.

Main outcome measures: Hospital LOS and total charges.

Results: A total of 1173 children with empyema were identified. Compared with children treated with primary nonoperative management, children treated with primary operative management had a shorter hospital LOS by 4.3 (95% confidence interval [CI], 2.3-6.4) days and lower total hospital charges by $21,179.80 (95% CI, -$34,111.12 to -$8248.48) and were less likely to be transferred to another short-term hospital (0% vs 13.3%). In addition, children with primary operative management were less likely to have therapeutic failure (odds ratio, 0.08 [95% CI, 0.04-0.15]). There was no difference in complications between the 2 groups (odds ratio, 1.01 [95% CI, 0.59-1.74]).

Conclusion: Primary operative management is associated with decreased LOS, hospital charges, and likelihood of transfer to another short-term hospital, compared with nonoperative management.

MeSH terms

  • Chest Tubes / statistics & numerical data
  • Child
  • Cohort Studies
  • Empyema, Pleural / economics*
  • Empyema, Pleural / surgery*
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Hospital Charges / statistics & numerical data*
  • Hospitals, Teaching / statistics & numerical data
  • Humans
  • Insurance, Health / statistics & numerical data
  • Length of Stay / economics
  • Length of Stay / statistics & numerical data*
  • Male
  • Patient Admission / statistics & numerical data
  • Retrospective Studies
  • Thoracic Surgery, Video-Assisted / statistics & numerical data
  • United States
  • Urban Population / statistics & numerical data


  • Fibrinolytic Agents