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DOI: 10.1055/s-0039-1678910
Current Surgical Treatment Strategies of Pleural Empyema
Publication History
Publication Date:
28 January 2019 (online)
Objective: Pleural empyema is a multifaceted and serious disease. The clinical importance is often underestimated and the morbidity and mortality rates are high despite the variety of modern treatment strategies. There are no evidence-based general treatment algorithms or randomized clinical trials. The aim of this study was to analyze the outcome of surgical therapy for patients suffering from pleural empyema.
Methods: We retrospectively analyzed all 157 patients with pleural empyema presenting to our department of thoracic surgery from January 2014 to December 2016. Patient demographics, microbiological findings, clinical course and mortality were evaluated. Results were compared in regard to the stage of empyema and the type of treatment.
Results: Majority of the patients had a stage III empyema (69.4%, 109/157). The predominant causes were pneumonia (44.6%, 70/157) and previous thoracic surgery (15.9%, 25/157). In 98.1% (154/157) of cases, surgery was performed (Thoracotomy: 82,5%, Thoracoscopy: 17.5%). Median length of postoperative hospitalization was 9 (6–19) days while stage and type of therapy did not have a statistically significant impact. Only 8 patients with stage III empyema were treated with thoracoscopy; 25% (2/8) of them needed to be re-operated with conversion to open decortication. The postoperative complication rate was higher within the open thoracotomy group (p = 0.047). Hospital mortality was 20.4% (32/157). Alcohol dependency, preexisting pulmonary illness and chronic renal disease were identified as significant risk factors.
Conclusion: Patients with severe pleural empyema carry a high risk with a mortally risk of 20%. Video assisted thoracoscopy is associated with a lower risk but only possible for stages I and II empyema. Stage III empyema mostly requires an open thoracotomy and decortication.