Urgent Video-Assisted Thoracoscopic Surgery After Penetrating Pediatric Trauma: A Propensity- Matched Analysis

INTRODUCTION : Outcomes following urgent video-assisted thoracoscopic surgery (VATS) after penetrating thoracic trauma in pediatric patients is unknown. We hypothesized that patients undergoing urgent VATS would have a higher risk of in-hospital mortality and complications, compared to similarly matched patients not undergoing VATS. METHODS : The 2017-2019 Trauma Quality Improvement Program database was queried for patients <17-years of age presenting after isolated penetrating thoracic trauma. Patients undergoing VATS within 6-hours were compared to those not undergoing VATS using a 1:1 propensity-score model. RESULTS : From 18,596 isolated penetrating trauma patients, 369 (2.0%) underwent VATS within six hours. 360 patients undergoing VATS were matched to 360 patients not undergoing VATS. There were no differences in age, sex, race, and comorbidities (all p>0.05). The VATS group had a higher rate of hypotension on admission (10.8% vs. 2.6%, p<0.001) and more often required blood transfusions within the first 4-hours (22.0% vs. 9.4%, p<0.001). The VATS group had a higher rate of injuries to the lung (26.1% vs. 11.4%, p<0.001), diaphragm (11.7% vs. 0.6%, p<0.001), spine (10.0% vs. 3.3%, p<0.001), and heart (5.3% vs. 0.6%, p<0.001). The overall rate and associated risk of major complications (5.8% vs. 0.3%, p<0.001; OR 22.24, CI 2.98-166.24, p=0.003) were higher in the VATS group, as was the risk of death (5.8% vs. 0.3%, p<0.001; OR 7.00 CI 2.06-23.77, p=0.002). CONCLUSION : Urgent pediatric VATS after isolated penetrating thoracic trauma occurs in 2% of cases. These patients have a 22-fold higher associated risk of complications and 7-fold higher risk of death.