To characterize how patients with empyemas are managed initially at our facility and to determine how “less aggressive” treatments (no drainage, repeat thoracentesis, tube thoracostomy) affect short term outcomes (inpatient mortality and need for a second intervention) compared to “more aggressive” treatments (intrapleural fibrinolytics, video-assisted thoracoscopic surgery, or other surgery). We will also assess if fewer patient co-morbidities, earlier diagnosis, earlier antibiotic treatment, and consulting appropriate services improve mortality.
A retrospective chart analysis was performed in a county teaching hospital in Los Angeles, California on seventy-two adult inpatients with parapneumonic empyemas. Mortality and need for second intervention rates were calculated and compared with data published in the 2000 American College of Chest Physicians Consensus Statement on the management of parapneumonic effusions using Fisher’s exact tests. Comparisons were made between empyema survivors and non-survivors using t-tests and chi-squared tests.
All 72 patients were managed with “less aggressive” initial treatments. There were no difference in mortality when our patients were compared to the literature’s “less aggressive” group (6% vs. 9%, P=0.40, RR 0.6, 95% CI: 0.23-1.62) or “more aggressive” group (6% vs. 3%, P=0.29, RR 1.8, 95% CI: 0.64-5.23). There was no difference between the second intervention rate of our patients and the “less aggressive” group (47% vs. 43%, P=0.47 RR 1.1, 95% CI: 0.86-1.42) although there was a difference when compared to the “more aggressive” group (47% vs. 11%, P<.0001, RR 4.5, 95% CI: 3.20-6.31). There were no differences in number of patient co-morbidities, time of diagnosis, timing of antibiotic treatment, or number of services consulted when survivors and non-survivors were compared.
Patients with empyemas at our hospital are treated with “less aggressive” initial treatments and have a higher second intervention rate when compared to patients described in the literature who were initially managed with “more aggressive” treatments.
Given these findings, it would be worthwhile to evaluate the impact of treating empyemas with “more aggressive” initial interventions at our institution.
Glena Cheng, None.