Empyema thoracis. Therapeutic management and outcome.
OBJECTIVE
We evaluated treatment and outcome of patients with thoracic empyema at a teaching institution.


METHODS
Retrospective chart review over a 44-month period at a university hospital.


METHODS
Charts of patients with a hospital discharge diagnosis of thoracic empyema were reviewed. Age, symptoms, alcohol use, empyema etiology, culture results, number of loculations, date and success of each procedure, length of hospital stay, and hospital discharge status were recorded for each patient. Success of procedure, recovery time, time between procedures, and total hospitalization time were compared between procedures and between subgroups.


RESULTS
Charts from 43 patients were reviewed. Twenty-four of 43 (56%) cases were parapneumonic empyemas. Forty of 43 (93%) patients had symptoms attributable to their empyema, with fever being the most common (65%). Seventy-nine procedures were needed to treat the 43 patients (1.84 procedures per patient). Success rates ranged from 11% (3/27) for tube thoracostomy to 95% (21/22) for decortication (p = 0.0001). Delay between procedures averaged 6.2 +/- 1.1 (mean +/- SEM) days between the first and second procedure (n = 27), and 10.4 +/- 5.1 days between the second and third procedure (n = 8). Mean recovery after successful intervention ranged from 9 to 19.3 days depending on the procedure (p = NS). Comparisons between multiloculated and uniloculated empyemas, parapneumonic and nonparapneumonic empyemas, and culture proven and biochemically proven empyemas showed no significant difference in procedure success rates or length of hospital stay.


CONCLUSIONS
Multiple therapeutic options exist for the treatment of thoracic empyema. Optimal therapy requires selection of the most appropriate first procedure for each patient with early postprocedure imaging to avoid inordinate delays between interventions.
LeMense
G P
GP
Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston 29425, USA.
Strange
C
C
Sahn
S A
SA
D001419:Bacteria / Q000302:isolation & purification; D002675:Child, Preschool; D016724:Empyema, Pleural / Q000382:microbiology / Q000628:therapy*; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies