title: Preoperative predictors of successful surgical treatment in the management of parapneumonic empyema.
abstract: BACKGROUND
  Video-assisted thoracoscopic surgery (VATS) and thoracotomy are the main surgical options for treating parapneumonic empyema. The choice of either operation depends on many preoperative features, including the patient's condition, clinical and radiologic findings, and pleural fluid characteristics. The identification of the combination of those preoperative findings that will allow surgeons to select the appropriate approach for a successful operation (VATS or thoracotomy) could be of great interest in clinical settings.
  
  
  METHODS
  We retrospectively reviewed a series of 97 patients who had undergone successful VATS or thoracotomy for parapneumonic empyema; in all cases, the operation had begun through VATS and was changed to a thoracotomy if a complete decortication was needed. Preoperative clinical, radiologic, and laboratory features were compared between the two groups to search for differences that might serve as predictive factors for either operation. Perioperative findings were also analyzed.
  
  
  RESULTS
  The operation was accomplished by VATS in 40 patients (41%), and conversion to thoracotomy was necessary in 57 (59%). Significant predictive factors for conversion were a prolonged delay from diagnosis to operation, the presence of fever and of pleural thickness on computed tomography (CT) images. The 25 patients who presented with these three features were cured by thoracotomy. The operative time and postoperative complication rate were significantly higher for the thoracotomy patients.
  
  
  CONCLUSIONS
  Some preoperative features can help the surgeon to better select patients for the appropriate operation. Delayed operation, fever, and pleural thickness can be used to predict the likelihood of conversion to thoracotomy.
authors.affiliation: Thoracic Surgery Unit, University of Modena and Reggio Emilia, Modena, Italy. Electronic address: alessandro.stefani@unimore.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Stefani
authors.forename: Beatrice
authors.initials: B
authors.lastname: Aramini
authors.forename: Giovanni
authors.initials: G
authors.lastname: della Casa
authors.forename: Guido
authors.initials: G
authors.lastname: Ligabue
authors.forename: Shaniko
authors.initials: S
authors.lastname: Kaleci
authors.forename: Christian
authors.initials: C
authors.lastname: Casali
authors.forename: Uliano
authors.initials: U
authors.lastname: Morandi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016724:Empyema, Pleural / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy; D055815:Young Adult
keywords: 14