title: Bedside modified Clagett procedure for empyema after pulmonary resection.
abstract: The objective of this study is to demonstrate the effectiveness and feasibility in treating empyema after pulmonary resection with a modified Clagett procedure performed at the bedside (BMCP). A retrospective review of a single surgeon's experience at a single institution was undertaken. All operative, postoperative, and outcome data were analyzed. Follow-up data were obtained from subsequent clinic charts. Five patients, including four males, were identified who underwent BMCP after pulmonary resection. The original operative procedures included two lobectomies, one pneumonectomy, one bilobectomy, and one bilateral metastastectomy. Patients were diagnosed with an empyema (positive thoracostomy tube culture, fever, and radiographic abnormality) at a mean time of 31 days from their initial procedure. Culture results disclosed Gram-positive empyemas in all patients. Three patients underwent BMCP as an outpatient, whereas the other two had BMCP during their hospitalizations. All patients are free from complications or recurrence at a mean follow up of 11.2 months. No patient required a further procedure after BMCP. The bedside modified Clagett procedure is both safe and effective. It is a valuable option in the management of postoperative empyema because it avoids additional operative procedures. This procedure is cost-effective when compared with operative management of perioperative empyema.
authors.affiliation: University of South Florida, Division of Cardiothoracic Surgery, Tampa, Florida, USA.
authors.forename: W Brent
authors.initials: WB
authors.lastname: Keeling
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Garrett
authors.forename: Nasreen
authors.initials: N
authors.lastname: Vohra
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Maxey
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Blazick
authors.forename: K Eric
authors.initials: KE
authors.lastname: Sommers
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002437:Cefazolin / Q000627:therapeutic use; D015505:Chest Tubes; D002981:Clindamycin / Q000627:therapeutic use; D016724:Empyema, Pleural / Q000188:drug therapy* / Q000382:microbiology; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects / Q000145:classification; D019095:Point-of-Care Systems; D011183:Postoperative Complications / Q000188:drug therapy* / Q000382:microbiology; D012189:Retrospective Studies; D012449:Safety; D013907:Thoracostomy; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D014640:Vancomycin; D002437:Cefazolin