Outcomes of video-assisted thoracoscopic decortication. 
Video-assisted thoracoscopic surgical decortication (VATSD) is widely used for treatment of early empyema and hemothorax, but conversion to open thoracotomy for decortication (OD) is more frequent in the setting of complex, chronic empyema.  This study compared indications for and outcomes associated with VATSD and OD.  The outcomes of 420 consecutive patients undergoing VATSD or OD for benign conditions from 1996 to 2006 were reviewed and compared with respect to baseline characteristics, preoperative management, and operative and postoperative course.  Patients were analyzed on an intention-to-treat basis.  The cohort consisted of 326 VATSD and 94 OD patients.  The conversion rate from VATSD to OD was 11.4%.  The operative time and median in-hospital length of stay were shorter for the VATSD group: 97 vs 155 minutes (p < 0.001), and 15 vs 21 days (p = 0.03), respectively.  The median postoperative length of stay was 7 days for the VATSD group vs 10 days for the OD group (p < 0.001).  Significantly fewer postoperative complications occurred in the VATSD group in the following categories: atelectasis, prolonged air leak, reintubation, ventilator dependence, need for tracheostomy, blood transfusion, sepsis, and 30-day mortality.  Thoracoscopic decortication for empyema, complex pleural effusion, and hemothorax yields results that are at least equivalent to open decortication.  Patients undergoing VATSD have fewer postoperative complications.  The conversion and reoperation rates are low, suggesting that a thoracoscopic approach is an effective and reasonable first option for most patients with complex pleural effusions and empyema.