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.
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