title: [Outcomes of Stage-Adapted Surgical Treatment of Pleural Empyema].
abstract: BACKGROUND
  The surgical treatment of pleural empyema should be carried out depending on the stage of the disease and the patient's symptoms. The aim of this study was to evaluate the outcomes of surgical pleural empyema treatment.
  
  
  METHODS
  Retrospective analysis of all patients with pleural empyema treated surgically between January 2008 and December 2013. The primary endpoint of the study was inpatient lethality. Secondary endpoints included duration of inpatient stay, type of treatment (surgical/conservative), proof of pathogen and type, alteration and duration of antibiotic therapy.
  
  
  RESULTS
  Of 359 patients, 0.8 % (n = 3) had stage I empyema, 50.4 % (n = 181) had stage II and 48.7 % (n = 175) had stage III. The most frequent causes (32.4 %) included acute pneumonia (parapneumonic pleural empyema), surgery (usually thoracic) in 18.0 % of cases and previous pneumonia (postpneumonic pleural empyema) in 15.4 %. Surgery was performed in 86 % of cases (operative procedures: open thoracotomy 85 %, VATS 15 %). The average duration of inpatient stay was 20 days for stages II and III. Recovery following VATS was significantly shorter in stage II compared to thoracotomy (p = 0.022). Hospital lethality amounted to 7.0 % (25 patients). The lethality rate was 5.5 % (10/185) in stage II and 8.6 % (15/175) in stage III. Patients with confirmed pathogens had a significantly worse mortality rate across all stages (9.8 %) than patients with no confirmed pathogens (4.0 %, p = 0.034). Age, malignant underlying disease, multiple comorbidities, immunosuppression, a change in antibiotic regimens and sepsis were significant risk factors.
  
  
  CONCLUSIONS
  The inpatient lethality of patients with pleural empyema correlates with the stage of the condition. Positive confirmation of pathogens, sepsis, a higher age, multiple comorbidities, malignant tumour disease, immunosuppression and a change of antibiotics are negative prognostic factors.
authors: Klinik für Thoraxchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Deutschland.
authors: Z
authors: Z
authors: Sziklavari
authors: Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Deutschland.
authors: J I
authors: JI
authors: Graml
authors: Zentrum für Klinische Studien, Universitätsklinikum Regensburg, Deutschland.
authors: F
authors: F
authors: Zeman
authors: Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Deutschland.
authors: M
authors: M
authors: Ried
authors: Klinik für Thoraxchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Deutschland.
authors: C
authors: C
authors: Grosser
authors: Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Deutschland.
authors: R
authors: R
authors: Neu
authors: Klinik für Thoraxchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Deutschland.
authors: T
authors: T
authors: Szöke
authors: Klinik für Thoraxchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Deutschland.
authors: H-S
authors: HS
authors: Hofmann
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000145:classification* / Q000401:mortality / Q000601:surgery*; D003131:Combined Modality Therapy; D016724:Empyema, Pleural / Q000145:classification* / Q000401:mortality / Q000601:surgery*; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D000069258:Thoracentesis / Q000379:methods; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D013908:Thoracotomy / Q000379:methods
chemical_list: D000900:Anti-Bacterial Agents