title: The surgical management of empyema thoracis in substance abuse patients: a 5-year experience.
abstract: Postpneumonic empyema (EMP) may develop in substance abuse patients, requiring prolonged hospitalization. An algorithm that provides quality care and a rational basis for timely surgical intervention would be advantageous. We report our five-year experience with EMP in substance abuse patients and present such a treatment plan. Sixty-one substance abuse patients were treated for EMP. Posteroanterior, lateral, and decubitus x-ray studies were obtained before treatment to assess fluid movement. Chest tubes were placed to drain frank pus and to obtain material for positive smears. X-ray studies and computed tomography were done 24 hours later to assess parenchymal pathology and to detect any multiple loculations. Thirty-three substance abuse patients recovered following initial tube thoracostomy and 7 after a second chest tube was introduced. Twenty-one had multiple loculations and underwent thoracotomy. Twenty of the 21 required extensive debridement or decortication, or both; 2 required lobectomy and 1 pneumonectomy. Chest tubes were removed on an average of 6 +/- 1.5 days. Average postoperative stay was 10.7 +/- 2 days. There were 2 early deaths and 1 late death and no recurrent EMP. Bacteriology findings were nonspecific and often polymicrobial. We conclude that early thoracotomy can be lifesaving in the presence of a benign clinical course.
authors.affiliation: Divisions of Thoracic Surgery, Meharry Medical College, Nashville, TN 37208.
authors.forename: E L
authors.initials: EL
authors.lastname: Hoover
authors.forename: H K
authors.initials: HK
authors.lastname: Hsu
authors.forename: H
authors.initials: H
authors.lastname: Webb
authors.forename: B
authors.initials: B
authors.lastname: Toporoff
authors.forename: E
authors.initials: E
authors.lastname: Minnard
authors.forename: J N
authors.initials: JN
authors.lastname: Cunningham
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004653:Empyema / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005260:Female; D003932:Heroin / Q000009:adverse effects; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D019966:Substance-Related Disorders / Q000150:complications / Q000601:surgery*
chemical_list: D003932:Heroin