title: Optimal timing of thoracoscopic drainage and decortication for empyema.
abstract: BACKGROUND
  Although video-assisted thoracic surgery (VATS) pleural drainage and decortication have been proven to be effective treatments in the early stages of empyema, the optimal timing of VATS is still not clear. To assess the effectiveness of early VATS drainage and decortication, we reviewed the records of patients who underwent VATS and open decortication for empyema.
  
  
  METHODS
  One hundred twenty-eight patients with empyema were treated with VATS and open decortication over 8 years at Korea University Anam Hospital. The VATS patients (120 patients) were divided into 3 groups based on the interval between the onset of chest symptoms and the time of operation (group 1: <2 weeks; group 2: 2 to 4 weeks; group 3: >4 weeks). Additional 8 open decortication patients with symptom durations greater than 4 weeks were compared with group 3 patients.
  
  
  RESULTS
  Groups 1 and 2 showed shorter chest tube duration, postoperative hospital stay, surgical procedure time, and fewer prolonged air leaks than group 3. No significant difference was noted between groups 1 and 2; and no difference was noted in the length of postoperative intensive care unit stays or the reintervention and reoperation rates among the 3 groups. In chronic empyema patients, group 3 showed shorter chest tube duration than the open decortication group.
  
  
  CONCLUSIONS
  Patients with symptom durations of less than 4 weeks showed better early results than those with symptom durations greater than 4 weeks. Thus, symptom duration can be considered a reliable preoperative factor in deciding the surgical management of empyema or cases involving loculated pleural effusion.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Seoul, South Korea.
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Chung
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Seoul, South Korea. Electronic address: sholeemd@korea.ac.kr.
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Seoul, South Korea.
authors.forename: Kwang Taik
authors.initials: KT
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Seoul, South Korea.
authors.forename: Jae Seung
authors.initials: JS
authors.lastname: Jung
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Seoul, South Korea.
authors.forename: Ho Sung
authors.initials: HS
authors.lastname: Son
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Seoul, South Korea.
authors.forename: Kyung
authors.initials: K
authors.lastname: Sun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015505:Chest Tubes; D002648:Child; D015331:Cohort Studies; D016208:Databases, Factual; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D016724:Empyema, Pleural / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D013510:Pulmonary Surgical Procedures / Q000009:adverse effects / Q000379:methods; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: 14