RESUMEN
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.
Asunto(s)
Empiema Pleural/cirugía , Hospitalización/estadística & datos numéricos , Tiempo de Internación/tendencias , Cirugía Torácica Asistida por Video/tendencias , Adolescente , Niño , Preescolar , Estudios de Cohortes , Bases de Datos Factuales , Manejo de la Enfermedad , Drenaje/métodos , Drenaje/estadística & datos numéricos , Empiema Pleural/diagnóstico por imagen , Empiema Pleural/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Pacientes Internos/estadística & datos numéricos , Modelos Logísticos , Masculino , Análisis Multivariante , Alta del Paciente/estadística & datos numéricos , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Cirugía Torácica Asistida por Video/métodos , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Estados UnidosAsunto(s)
Anestesia/tendencias , Anestesiología/tendencias , Cirugía Torácica Asistida por Video/tendencias , Anestesia/métodos , Anestesia de Conducción/métodos , Anestesia de Conducción/tendencias , Anestesiología/métodos , Humanos , Enfermedades Pulmonares/cirugía , Cirugía Torácica Asistida por Video/métodos , Procedimientos Quirúrgicos Torácicos/métodos , Procedimientos Quirúrgicos Torácicos/tendenciasRESUMEN
A cirurgia robótica do tórax encontra-se ao final da sua primeira década de existência; apesar disso, os seus resultados iniciais são compatíveis com as técnicas videoassistidas das praticadas nos grandes centros acadêmicos nos últimos 20 anos. A evolução tecnológica constante dos instrumentos de imagem, miniaturização dos sistemas robóticos econsequente aprimoramento da relação homem-máquina com dispositivos interativos mais precisos apontam umcaminho promissor para a robótica em cirurgia. Neste artigo, revisamos alguns dos principais elementos da cirurgia robótica, as suas atuais vantagens edesvantagens comparadas a outras técnicas minimamenteinvasivas, trazendo perspectivas sobre o seu presente efuturo.