title: Modern management of thoracic empyema.
abstract: OBJECTIVE
  Historically, surgical management of empyema was performed predominantly via open thoracotomy; however, during the past decade the use of video-assisted thoracoscopic surgery (VATS) as an alternative has increased. This study retrospectively compared the outcomes and management of patients with empyema at the University of Kentucky Medical Center who had undergone VATS versus those receiving open thoracotomy to determine whether VATS decortication provided comparable results.
  
  
  METHODS
  Adult patients who had undergone open thoracotomy or VATS decortication for empyema between 2005 and 2009 at the University of Kentucky were identified by querying the hospital's cardiothoracic surgery database. Patients were sorted by procedure on an intent-to-treat basis. Comorbid conditions, preoperative course, operative outcomes, and postoperative outcomes were compared. Quantitative data were analyzed with either an unpaired t test or the Mann-Whitney U test. Qualitative data were analyzed using the Fisher exact test.
  
  
  RESULTS
  Fifty-three patients were identified, 18 of whom underwent VATS and 35 underwent open thoracotomy. Eight of the 18 VATS procedures (44.4%) were converted to open thoracotomy. Patients undergoing VATS had a significantly shorter median length of stay (11 vs 18 days, respectively; P = 0.044), chest tube duration (6 vs 12 days, respectively; P < 0.001), operative blood loss (55.6 vs 344 mL, respectively; P = 0.003), and fewer postoperative respiratory failures (0% vs 22.9%, respectively; P = 0.0451). The two groups did not differ significantly in overall morbidity, reoperation, mortality, or preoperative comorbidities.
  
  
  CONCLUSIONS
  In adults, VATS offers results comparable to those of open thoracotomy, and lengths of stay, chest tube durations, and postoperative outcomes are superior. Although the conversion rate of VATS to open thoracotomy at our institution was high (38.1%) compared with studies at other institutions, the data still indicate that VATS is both a safe and reliable alternative to open thoracotomy.
authors.affiliation: From the Department of Surgery, Division of Cardiothoracic Surgery, and College of Medicine, University of Kentucky, Lexington.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Bender
authors.affiliation: From the Department of Surgery, Division of Cardiothoracic Surgery, and College of Medicine, University of Kentucky, Lexington.
authors.forename: Victor A
authors.initials: VA
authors.lastname: Ferraris
authors.affiliation: From the Department of Surgery, Division of Cardiothoracic Surgery, and College of Medicine, University of Kentucky, Lexington.
authors.forename: Sibu P
authors.initials: SP
authors.lastname: Saha
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D015505:Chest Tubes / Q000706:statistics & numerical data; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data*; D016208:Databases, Factual; D016724:Empyema, Pleural / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D019616:Thoracic Surgical Procedures / Q000379:methods; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome