Empyema in adults and children: difference in surgical approaches, report of 139 cases.
OBJECTIVE
We investigated specific aetiology and different therapeutic approaches in patients with empyema in a General Thoracic Surgery Clinic.


METHODS
Charts of 139 patients admitted with empyema, between January 1998 and March 2005 were retrospectively reviewed. Although not completely comparable, patients were divided into two groups; Paediatric (n = 71) and adult (n = 68) cases. In addition to demographic characteristics, treatment options, complications and clinical outcomes were investigated according to the specific group.


RESULTS
The mean age was 5.6 years (4 mo - 17 y) for paediatric patients and 49.6 years (20-81 y) for adult patients. Overall, 65% of the patients (n = 91) were male. All paediatric cases had parapneumonic empyema, while 63% of the adult cases had parapneumonic and 23.5% had postoperative empyema. Of the paediatric cases, 50% received fibrinolytic treatment in addition to tube thoracostomy and 35% had decortication. In adults, 42% had tube thoracostomy and fibrinolytic treatment, and decortication was required in 9% only. Thoracomyoplasty was performed in 12% of the patients (n = 8). We had no mortality in paediatric patients, however mortality rate was 8% in the adult group. Morbidity, consisted mostly of prolonged air leakage and impaired lung expansion.


CONCLUSIONS
Early decortication and fibrinolytic treatment are sufficient for paediatric patients, while a variety of techniques including open drainage, rib resection and thoracomyoplasty are required in adult patients with empyema.
Nadir
A
A
Department of Thoracic Surgery, Cumhuriyet University, School of Medicine, Sivas, Turkey.
Kaptanoglu
M
M
Gonlugur
U
U
Cevit
O
O
Sahin
E
E
Akkurt
I
I
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000706:statistics & numerical data; D016724:Empyema, Pleural / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000150:complications; D011183:Postoperative Complications; D012189:Retrospective Studies; D013905:Thoracoplasty / Q000706:statistics & numerical data; D013907:Thoracostomy / Q000706:statistics & numerical data; D014421:Turkey / Q000453:epidemiology
D005343:Fibrinolytic Agents