PURPOSE: Minimally-invasive surgery for pleural empyema has been popularized over the last l0 years, even though its advantage over open-procedures is still controversial. Videothoracoscopy for pleural empyema management started to be widely used in our facility in 2005. Our aim was to evaluate the impact of videothoracoscopy in surgical management of pleural empyema.
METHODS: Retrospective analysis of all patients that underwent pleural and pulmonary decortication for pleural empyema in our institution from 2003 to 2007 . The studied patients were divided in two groups: Group 1, patients operated on from January 2003 until December 2004; Group 2, patients operated on from January 2006 until December 2007. Outcome of both groups were compared. Fisher, T-Student, MannWhitney and Chi-square tests were used when appropriate, P<0.05 was considered significant.
RESULTS: 71 patients comprised Group 1 (G1) and 67 comprised Group 2 (G2). 12% of the patients underwent videothoracoscopy in Group 1 while 57% of the patients underwent videothoracoscopy in Group 2 (p<0.01), all other patients underwent open decortication. There was no difference between groups regarding: operation time (193min (G1) and 202 min (G2)); chest tube time (6.5 days (G1) and 7 days(G2)); postoperative ICU time (4.3 days (G1) and 3.9 days (G2)), complication rate (22.5% (G1) and 14% (G2)); reoperations (4.2% (G1) and 4.4% (G2)); and mortality (14% (G1) and 11% (G2)). Patients in G2 were older (46.1 years vs. 39.1, p=0.011) and were referred for decortication earlier ( 12.6 days vs 14.9 days, p=0.011).
CONCLUSION: A wider use of videothoracoscopy had not significantly changed the outcome for empyema management on our Institution. Apparently it encouraged clinicians to refer older patients as well as refer patients earlier for surgical treatment.
CLINICAL IMPLICATIONS: Videothoracoscopy had no negative impact on pleural empyema management, actually it stimulated earlier referral and inclusion of older patients.
DISCLOSURE: Ricardo Terra, No Financial Disclosure Information; No Product/Research Disclosure Information