We appreciate Weinstein and Cohen's thoughtful comments on our article on primary operative management (POM) for pediatric empyema.1 Our study compared POM (VATS or open decortication in the first 2 days of hospitalization) with nonoperative management. The nonoperative management group consisted of all children who were not considered to have undergone POM and thus included all patients initially treated nonoperatively: (1) patients treated with antibiotics alone (24%), (2) patients requiring chest tube placement—with or without fibrinolysis (44%), and (3) patients requiring eventual decortication (30%). We found that POM was associated with a 4-day shorter hospital stay and decreased hospital charges by about $20 000 compared with nonoperative management.
Li ST, Gates RL. Hold Those Scalpels—Reply. Arch Pediatr Adolesc Med. 2008;162(7):698-699. doi:10.1001/archpedi.162.7.698-b