title: Thoracotomy and decortication: impact of culture-positive empyema on the outcome of surgery.
abstract: OBJECTIVE
  This study aimed to assess the efficacy of thoracotomy and decortication (T/D) in achieving lung re-expansion in patients with Stage III empyema and assess the impact of culture-positive empyema on the outcome of decortication.
  
  
  METHODS
  This is a retrospective observational study of consecutive patients treated with T/D over a 6-year period.
  
  
  RESULTS
  A total of 107 consecutive patients were identified. The median age was 55 (range 16-86) years; of which, 86% were male. The median length of hospital stay was 9 (range 2-45) days. Full lung re-expansion was achieved in 86% of cases. There were no postoperative deaths. Pleural cultures were positive in 56 (52%) cases. Patients with culture-positive empyema had a longer duration of pleural drainage (median of 11 days, range 3-112 versus median of 5 days, range 3-29 days for negative culture; P = 0.0004), longer length of hospital stay (median of 11 days, range 4-45 versus median of 7 days, range 2-34 days; P = 0.0002) and more complications (P = 0.0008), respectively. There was no statistically significant difference in the outcome of surgery, i.e. lung re-expansion versus trapped lung (P = 0.08) between the two groups.
  
  
  CONCLUSIONS
  T/D is safe and achieved lung re-expansion in the majority of patients. Culture-positive empyema was associated with worse outcomes.
authors.affiliation: Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK l.okiror@doctors.org.uk.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Okiror
authors.affiliation: Department of Clinical Infection Services, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Cordelia
authors.initials: C
authors.lastname: Coltart
authors.affiliation: Department of Thoracic Surgery, Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bille
authors.affiliation: Department of Clinical Infection Services, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Lucy
authors.initials: L
authors.lastname: Guile
authors.affiliation: Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Pilling
authors.affiliation: Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Harrison-Phipps
authors.affiliation: Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Routledge
authors.affiliation: Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Loic
authors.initials: L
authors.lastname: Lang-Lazdunski
authors.affiliation: Department of Clinical Infection Services, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Hemsley
authors.affiliation: Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Juliet
authors.initials: J
authors.lastname: King
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000302:isolation & purification; D016724:Empyema, Pleural / Q000382:microbiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010994:Pleura / Q000382:microbiology / Q000601:surgery; D012189:Retrospective Studies; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bacterial culture; Stage III empyema; Thoracotomy and decortication