PURPOSE: The extent and timing of surgery for empyema thoracis remains controversial. The aim of this study was to evaluate the outcome of early thoracotomy in the management of complex empyema in adults.
METHODS: A retrospective review of adult patients with empyema who underwent thoracotomy between 01/1999 and 12/2005 was conducted using hospital and individual surgeon databases. All patients were treated according to a standard protocol by three certified general thoracic surgeons based at a tertiary referral centre.
RESULTS: Of 299 patients with a discharge diagnosis of empyema, 140 patients (mean age 57 years, range 22-88 years; male n=91, female n=49) underwent thoracotomy. Patients were referred with ongoing symptoms of pulmonary sepsis (mean, 5 weeks duration) having failed various medical therapies. The most frequent etiology was parapneumonic 69% (97/140), although microorganisms were isolated from only 11 % (12/110) of available cultures. Based on CT scanning, all were judged to have complex (Class III) empyema (right n=71; left n=69). All patients underwent immediate thoracotomy and decortication. Postoperative in-hospital mortality was 2% (3/140). The leading cause of morbidity was air leak 7% (10/140), resulting in prolonged chest tube drainage (mean 17 days vs. 8 days if uncomplicated P=0.0006). Mean postoperative ICU stay was 2 days (range 1-26 days), and overall hospital stay 11 days (range 5-30 days). 98% (134/137) of patients achieved radiographic resolution; only 3 patients had a residual pleural space requiring further intervention.
CONCLUSION: We conclude that early thoracotomy and decortication may be performed safely in adults with ongoing sepsis resulting from complex empyema.
CLINICAL IMPLICATIONS: In the management of complex empyema in adults, early thoracotomy and decortication performed in a specialist thoracic unit is associated with excellent outcome.
DISCLOSURE: Alan Casson, No Financial Disclosure Information; No Product/Research Disclosure Information