{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T02:37:37Z","timestamp":1784774257752,"version":"3.55.0"},"reference-count":14,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2024,4,4]],"date-time":"2024-04-04T00:00:00Z","timestamp":1712188800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Video-assisted thoracoscopic surgery (VATS) is a practical resource in the management of traumatic hemothorax. However, it carries inherent risks and should be mobilized cost-effectively. In this study, we investigated the ideal VATS timing using cost analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>617 cases of unilateral traumatic hemothorax from 2012 to 2022 were identified in our trauma database. We extracted encounter cost, length of stay (LOS), and operative cost information. Using Kruskal-Walli\u2019s test, we compared the cost and LOS for patients who underwent VATS or continued nonoperative management in the first 7\u00a0days of admission. Additionally, we computed the daily proportion of patients initially managed nonoperatively but ultimately underwent VATS. P-values &lt;.05 were considered significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median encounter cost of cases managed operatively before hospital day 4 (HD4) was higher than those managed nonoperatively. This difference was $63k on HD2 ( P-value .07) and was statistically significant for HD3 (difference of $65k, P-value .02). The median LOS with operational management on HD2 and 3 was 7 and 6 respectively vs median LOS of 2 and 3 with nonoperative management on those days ( P-value &lt;.001, .01 respectively). The proportion of patients who failed nonoperative management did not change from baseline until HD4 (23% (95% CI 19.7, 26.3) vs 33.9% (95% CI 28.3, 39.6), P-value &lt;.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Early mobilization of VATS before hospital day 4 increases the overall hospital cost without offering any length of stay benefit. Continuing nonoperative management longer than 4\u00a0days is associated with a high failure rate and a costlier operation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348241244638","type":"journal-article","created":{"date-parts":[[2024,4,4]],"date-time":"2024-04-04T22:04:50Z","timestamp":1712268290000},"page":"2149-2155","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Not So Vats: How Early Is Too Early in the Operative Management of Patients with Traumatic Hemothorax?"],"prefix":"10.1177","volume":"90","author":[{"given":"Chinweotuto V.","family":"Uma","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William B.","family":"Risinger","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suhail","family":"Nath","sequence":"additional","affiliation":[{"name":"Financial Director, UofL Health-University Hospital, Louisville, KY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel J.","family":"Pera","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason W.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,4,4]]},"reference":[{"key":"bibr1-00031348241244638","doi-asserted-by":"publisher","DOI":"10.1097\/CPM.0000000000000343"},{"key":"bibr2-00031348241244638","doi-asserted-by":"publisher","DOI":"10.1016\/s0039-6109(05)70477-1"},{"key":"bibr3-00031348241244638","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2010.08.006"},{"key":"bibr4-00031348241244638","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2017.03.52"},{"key":"bibr5-00031348241244638","doi-asserted-by":"publisher","DOI":"10.1016\/j.thorsurg.2012.10.003"},{"key":"bibr6-00031348241244638","doi-asserted-by":"publisher","DOI":"10.1097\/MCC.0b013e328010b833"},{"key":"bibr7-00031348241244638","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e318242e368"},{"key":"bibr8-00031348241244638","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2020.11.032"},{"key":"bibr9-00031348241244638","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-012-1016-7"},{"key":"bibr10-00031348241244638","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2022.07.021"},{"key":"bibr11-00031348241244638","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2021.03.030"},{"key":"bibr12-00031348241244638","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3182223080"},{"key":"bibr13-00031348241244638","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000001370"},{"key":"bibr14-00031348241244638","doi-asserted-by":"publisher","DOI":"10.1097\/ta.0b013e31825132a0"}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348241244638","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00031348241244638","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348241244638","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T12:39:48Z","timestamp":1777379988000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00031348241244638"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,4]]},"references-count":14,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1177\/00031348241244638"],"URL":"https:\/\/doi.org\/10.1177\/00031348241244638","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,4]]}}}