Primary operative management for pediatric empyema: decreases in hospital length of stay and charges in a national sample.

OBJECTIVE

To determine whether primary operative management (decortication within the first 2 days of hospitalization) decreases hospital length of stay (LOS) and total charges in children with empyema.

DESIGN

Retrospective cohort study.

SETTING

Nationally representative Kids' Inpatient Database for 2003.

PARTICIPANTS

Children and adolescents aged 0 to 18 years (hereinafter referred to as children) with empyema.

MAIN OUTCOME MEASURES

Hospital LOS and total charges.

RESULTS

A total of 1173 children with empyema were identified. Compared with children treated with primary nonoperative management, children treated with primary operative management had a shorter hospital LOS by 4.3 (95% confidence interval [CI], 2.3-6.4) days and lower total hospital charges by $21,179.80 (95% CI, -$34,111.12 to -$8248.48) and were less likely to be transferred to another short-term hospital (0% vs 13.3%). In addition, children with primary operative management were less likely to have therapeutic failure (odds ratio, 0.08 [95% CI, 0.04-0.15]). There was no difference in complications between the 2 groups (odds ratio, 1.01 [95% CI, 0.59-1.74]).

CONCLUSION

Primary operative management is associated with decreased LOS, hospital charges, and likelihood of transfer to another short-term hospital, compared with nonoperative management.