title: Acute thoracic empyema: clinical characteristics and outcome analysis of video-assisted thoracoscopic surgery.
abstract: OBJECTIVE
  Acute thoracic empyema is a common clinical problem worldwide, resulting in substantial morbidity and mortality. The objective of this study was to report its clinical characteristics and to evaluate whether thoracoscopic surgery is associated with a lower rate of in-hospital mortality compared with nonoperative drainage.
  
  
  METHODS
  Between 2001 and 2010, we retrospectively reviewed the clinical characteristics, bacteriological studies, and treatment outcomes of 602 patients with acute thoracic empyema. Thoracoscopic surgery was performed in 417 (69.2%) patients, while the remaining patients underwent nonoperative drainage. After treatment, 77 patients (12.8%) died in the hospital. A propensity score-based process, matched on potential risk factors for in-hospital mortality, was performed to select patients with equalized potential prognostic factors in the thoracoscopy and nonoperative groups. The log-rank test was used to compare the survival time with discharge between the two matched groups.
  
  
  RESULTS
  Multivariate analysis showed that age, malignancy, chronic lung disease, chronic renal insufficiency, liver cirrhosis, polymicrobial infection, and positive bacterial culture were risk factors for in-hospital mortality. The propensity score-matched analysis showed that the in-hospital mortality difference was significant (p = 0.014) and the Kaplan-Meier survival analysis revealed a higher survival rate to discharge (p < 0.001 by log-rank test), both favoring thoracoscopy over nonoperative drainage.
  
  
  CONCLUSIONS
  Acute thoracic empyema carries a high mortality rate, especially in elderly patients with coexisting medical conditions and polymicrobial and positive bacterial cultures. Our study results also showed that thoracoscopy is feasible and might provide better chances for survival in borderline operable patients than nonoperative drainage.
authors: Institute of Biomedical Engineering, College of Engineering, National Taiwan University, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Dou-Liou, Taiwan; Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
authors: Ke-Cheng
authors: KC
authors: Chen
authors: Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.
authors: Hsuan-Yu
authors: HY
authors: Chen
authors: Cardiovascular Center and Health Management Center, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Dou-Liou, Taiwan.
authors: Jou-Wei
authors: JW
authors: Lin
authors: Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Dou-Liou, Taiwan.
authors: Yu-Ting
authors: YT
authors: Tseng
authors: Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
authors: Shuenn-Wen
authors: SW
authors: Kuo
authors: Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
authors: Pei-Ming
authors: PM
authors: Huang
authors: Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
authors: Hsao-Hsun
authors: HH
authors: Hsu
authors: Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: jangminglee@gmail.com.
authors: Jang-Ming
authors: JM
authors: Lee
authors: Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Dou-Liou, Taiwan; Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: chenjs@ntu.edu.tw.
authors: Jin-Shing
authors: JS
authors: Chen
authors: Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: hslai@ntu.edu.tw.
authors: Hong-Shiee
authors: HS
authors: Lai
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D016724:Empyema, Pleural / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted
keywords: empyema; outcome; propensity analysis; video-assisted thoracoscopic surgery