title: Poor late survival after surgical treatment of pleural empyema.
abstract: BACKGROUND
  We have evaluated the outcome of patients who underwent surgical treatment of parapneumonic pleural empyema.
  
  
  METHODS
  This study included 143 consecutive patients older than 18 years who were operated on for parapneumonic pleural empyema.
  
  
  RESULTS
  The overall survival at 30 days, 3 months, 5 years, and 10 years was 97.2, 92.3, 80.6, and 61.9%, respectively. Serum albumin (OR = 0.78, 95% CI = 0.65-0.94), cerebrovascular disease (OR = 30.49, 95% CI = 1.35-689.05), pulmonary embolism (OR = 984.63, 95% CI = 7.81-124206.8), and Thoracoscore (OR = 1.61, 95% CI = 1.10-2.35) were independent predictors of 3-month overall survival. Age (RR = 1.08, 95% CI = 1.03-1.14), serum albumin (RR = 0.89, 95% CI = 0.82-0.98), chronic obstructive pulmonary disease (COPD) (RR = 5.14, 95% CI = 1.3319.84), and cerebrovascular disease (RR = 6.76, 95% CI = 1.33-34.34) were independent predictors of pneumonia/pleural empyema-related death. Twenty-two patients required 33 reinterventions after the primary procedure: 19 patients after primary thoracoscopy and 3 patients after primary thoracotomy. Reintervention did not have any significant impact on 30-day mortality (4.5% vs. 2.5%, p = 0.49), but it affected 3-month mortality (26.1% vs. 4.2%, p < 0.0001). Reoperation was an independent predictor of late overall survival (at 10 years: 35.5% vs. 67.4%, RR = 2.95, 95% CI = 1.33-6.57) and freedom from pneumonia/pleural empyema-related death (at 10 years: 73.9% vs. 91.3%, RR = 4.40, 95% CI = 1.24-15.66).
  
  
  CONCLUSIONS
  Surgical treatment of pleural empyema can be associated with good immediate results, but longer follow-up showed that pneumonia/pleural empyema-related mortality and all-cause mortality are rather poor.
authors.affiliation: Division of Cardio-thoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland.
authors.forename: Reija
authors.initials: R
authors.lastname: Mikkola
authors.forename: Janna
authors.initials: J
authors.lastname: Kelahaara
authors.forename: Jouni
authors.initials: J
authors.lastname: Heikkinen
authors.forename: Jarmo
authors.initials: J
authors.lastname: Lahtinen
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
mesh_terms: D016724:Empyema, Pleural / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012372:ROC Curve; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D015996:Survival Rate; D013906:Thoracoscopy; D013908:Thoracotomy; D016896:Treatment Outcome