title: Surgical decortication as the first-line treatment for pleural empyema.
abstract: OBJECTIVE
  The study objective was to evaluate the clinical outcomes of surgical decortication as the first line of treatment for pleural empyema.
  
  
  METHODS
  We analyzed the medical records of 111 patients who presented with empyema and were treated with simple drainage or surgical decortication as the first line of treatment at Gangnam Severance Hospital, a tertiary referral medical center in Seoul, Korea.
  
  
  RESULTS
  Of 111 patients with empyema, 27 underwent surgical decortication as the first intervention. Surgical decortication showed a better treatment success rate in all study subjects (96.3%, 26/27 patients) compared with simple drainage (58.3%, 49/84 patients; P < .0001 for method comparison). After propensity-scored matching, decortication resulted in a better outcome (95.0%, 19/20 patients) versus drainage (56.7%, 17/30 patients; P = .003). Surgical decortication as the first line of treatment for empyema was the best predictor of treatment success after adjustment for compounding factors (odds ratio, 14.529; 95% confidence interval, 1.715-123.074; P = .014).
  
  
  CONCLUSIONS
  The first treatment choice for pleural empyema is a critical determinant of ultimate therapeutic success. After adjusting for confounding variables, surgical decortication is the optimal first treatment choice for advanced empyema.
authors.affiliation: Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Jung Ar
authors.initials: JA
authors.lastname: Shin
authors.affiliation: Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Yoon Soo
authors.initials: YS
authors.lastname: Chang
authors.affiliation: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Gangnam Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Seok Jin
authors.initials: SJ
authors.lastname: Haam
authors.affiliation: Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Hyung Jung
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Chul Min
authors.initials: CM
authors.lastname: Ahn
authors.affiliation: Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea. Electronic address: littmann@yuhs.ac.
authors.forename: Min Kwang
authors.initials: MK
authors.lastname: Byun
mesh_terms: D016724:Empyema, Pleural / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000379:methods