Retained hemothorax remains a common problem after thoracic trauma with associated
morbidity and prolonged hospitalizations. The goal of this study was to examine the
impact of time to video assisted thoracoscopic surgery (VATS) on pulmonary morbidity
using a large, national data set.
Patients undergoing VATS for retained hemothorax within the first 14 days postinjury
were identified from the Trauma Quality Improvement Program database over 5 years,
ending in 2016. Demographics, mechanism, severity of injury, severity of shock, time
to VATS, pulmonary morbidity, and mortality were recorded. Multivariable logistic
regression analysis was performed to determine independent predictors of pulmonary
morbidity. Youden’s index was then used to identify the optimal time to VATS.
From the Trauma Quality Improvement Program database, 3,546 patients were identified.
Of these, 2,355 (66%) suffered blunt injury. The majority were male (81%) with a median
age and Injury Severity Score of 46 and 16, respectively. The median time to VATS
was 134 hours. Both pulmonary morbidity (13 vs 17%, P = .004) and hospital length of stay (9 vs 12 days, P < .0001) were significantly reduced in patients undergoing VATS before 3.9 days.
Multivariable logistic regression identified VATS during the first 7 days as the only
modifiable risk factor significantly associated with reduced pulmonary morbidity (odds
ratio 0.52; 95% confidence interval 0.43–0.63, P < .0001).
Patients undergoing VATS for retained hemothorax have significant morbidity and prolonged
length of stay. VATS within the first week of admission results in fewer pulmonary
complications and shorter length of stay. In fact, the optimal time to VATS was identified
as 3.9 days and was the only modifiable risk factor associated with decreased pulmonary