Trends in Hospital Treatment of Empyema in Children in the United States

J Pediatr. 2018 Nov;202:245-251.e1. doi: 10.1016/j.jpeds.2018.07.004. Epub 2018 Aug 28.

Abstract

Objective: To evaluate trends in procedures used to treat children hospitalized in the US with empyema during a period that included the release of guidelines endorsing chest tube placement as an acceptable first-line alternative to video-assisted thoracoscopic surgery.

Study design: We used National Inpatient Samples to describe empyema-related discharges of children ages 0-17 years during 2008-2014. We evaluated trends using inverse variance weighted linear regression and characterized treatment failure using multivariable logistic regression to identify factors associated with having more than 1 procedure.

Results: Empyema-related discharges declined from 3 in 100 000 children to 2 in 100 000 during 2008-2014 (P = .04, linear trend). There was no significant change in the proportion of discharges having 1 procedure (66.1% to 64.1%) or in the proportion having 2 or more procedures (22.1% to 21.6%). The proportion coded for video-assisted thoracoscopic surgery as the only procedure declined (41.4% to 36.2%; P = .03), and the proportions coded for 1 chest tube (14.6% to 20.9%; P = .04) and 2 chest tube procedures (0.9% to 3.5%; P < .01) both increased. The median length of stay for empyema-related discharges remained unchanged (9.3 days to 9.8 days; P = .053). Having more than 1 procedure was associated with continuous mechanical ventilation (adjusted OR, 2.7; 95% CI, 1.8-4.1) but not with age, sex, payer, chronic conditions, transfer admission, hospital size, or census region.

Conclusions: The use of video-assisted thoracoscopic surgery to treat children in the US hospitalized with empyema seems to be decreasing without associated increases in length of stay or need for additional drainage procedures.

Keywords: pleural empyema; pneumonia; thoracostomy; video-assisted thoracoscopic surgery.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Cohort Studies
  • Databases, Factual
  • Disease Management
  • Drainage / methods
  • Drainage / statistics & numerical data
  • Empyema, Pleural / diagnostic imaging
  • Empyema, Pleural / epidemiology
  • Empyema, Pleural / surgery*
  • Female
  • Hospitalization / statistics & numerical data*
  • Humans
  • Infant
  • Infant, Newborn
  • Inpatients / statistics & numerical data
  • Length of Stay / trends*
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Patient Discharge / statistics & numerical data
  • Prognosis
  • Retrospective Studies
  • Severity of Illness Index
  • Thoracic Surgery, Video-Assisted / methods
  • Thoracic Surgery, Video-Assisted / trends*
  • Tomography, X-Ray Computed / methods
  • Treatment Outcome
  • United States