title: Is open decortication superior to fibrinolytic therapy as a first line treatment in the management of pleural empyema?
abstract: OBJECTIVE
  To confirm that either Fibrinolytic therapy or open decortication which of the two is an effective First line treatment of pleural empyema.
  
  
  METHODS
  This prospective comparative study was conducted in the department of surgery Sheikh Zayed Medical College and Hospital, Rahim Yaar Khan. Seventy eight (78) patients were included in this study. There were two groups of patients; Group I (n=35) patients treated with fibrinolytic therapy, Group II (n=43) patients treated with open decortication. Data was entered and analyzed in SPSS v16. Student's t-test was used for comparison of quantitative variables. Chi-square and Fisher's Exact test were used for comparison of qualitative variables. P-value ≤ 0.05 was taken as significant difference.
  
  
  RESULTS
  There was no significant difference in base baseline characteristics of patients of Group I and II. Incidence of comorbidities was also same between the groups. Most of the patients in Group I and II were in empyema stage III. Fluid cultures was positive in 33 (94.3%) patients in group I and 39 (90.7%) patients in group II. 30 (85.7%) was successfully treated using fibrinolytic therapy but this therapy failed in five (14.3%) patients, two of these patients expired within the hospital. There was only one (2.3%) treatment failure in open decortication Group that patient expired within the hospital (p-value 0.04). Overall duration of hospitalization was significantly high in fibrinolytic group, this was 17.6± 1.95 days versus 12.09± 2.18 days in open decortication group (p-value<0.0001). There was no significant difference regarding operative mortality within the two groups.
  
  
  CONCLUSIONS
  Open Drainage is associated with better outcomes as compared to fibrinolytic therapy when used as a First line treatment of empyema.
authors.affiliation: Sultan Ahmed (FCPS General Surgery), Assistant Professor of General Surgery, Sheikh Zayed Medical College & Hospital, Rahim Yaar Khan, Pakistan.
authors.forename: Sultan
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Hammad Azam (FCPS General Surgery), Assistant Professor of Cardiac Surgery, Sheikh Zayed Medical College & Hospital, Rahim Yaar Khan, Pakistan.
authors.forename: Hammad
authors.initials: H
authors.lastname: Azam
authors.affiliation: Imran Basheer (FCPS Pulmonology), Assistant Professor of Pulmonology, Sheikh Zayed Medical College & Hospital, Rahim Yaar Khan, Pakistan.
authors.forename: Imran
authors.initials: I
authors.lastname: Basheer
keywords: Empyema; Fibrinolytic therapy; Open Decortication