Summary of the data from a systematic review of primary operative versus nonoperative therapy for pediatric empyema

Outcome	Antibiotics and chest tube (n = 3183)	Fibrinolytic therapy* (n = 64)	VATS (n = 176)	Thoracotomy (n = 175)
Mortality rate (range)	3.3% (0 to 35%)	0%	0%	0%
Failure rate^¶ (range)	23.6% (0 to 67%)	9.4% (6.7 to 14.2%)	2.8%	3.1%
Length of stay	20±8.3 days	10.7±5.1 days	11.2 days	10.6 days
Duration of chest tube	10.6±3.4 days	4 days	4 days	6.2 days
Duration of antibiotics	21.3±7.9 days	Not specified	13.2 days	Not specified
Complication rate^Δ (range)	5.6% (0 to 45%)	12.5% (0 to 16.6%)	5.4%	5.2%

VATS: video-assisted thoracoscopic surgery.
* Fibrinolytic therapy: treatment with fibrinolytics either at the time of or within 24 hours of tube thoracostomy.
¶ Failure: failure of primary intervention necessitating subsequent operative intervention.
Δ Complications typically included pneumothorax, bronchopleural fistula, persistent or recurrent empyema, bleeding, and wound infection.

Adapted from Avansino, JR, Goldman, B, Sawin, RS, Flum, DR. Primary operative versus nonoperative therapy for pediatric empyema: a meta-analysis. Pediatrics 2005; 115:1652.

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Summary of the data from a systematic review of primary operative versus nonoperative therapy for pediatric empyema