DECORTICATION FOR CHRONIC POSTPNEUMONIC EMPYEMA

BACKGROUND: Thoracic empyema after pneumonia continues to be a source of morbidity and mortality. Despite the widespread use of antibiotics, more than 50 percent of empyemas are secondary to a primary pulmonary process. An empyema present for four to six weeks is considered chron ic and can severely restrict the movement of the entire hemithorax. ST UDY DESIGN: Twenty-five adult patients with chronic, postpneumonic emp yema required decortication at the Bronx Municipal Hospital Center bet ween 1988 and 1990. Only patients with chronic postpneumonic empyema w ere included. All patients failed conservative treatment with antibiot ics and tube drainage. Decortication was required to control infection and release the pulmonary entrapment.RESULTS: Patients were often deb ilitated from alcoholism (52 percent), drug addiction (32 percent), an d chronic disease. Ten patients (40 percent) required additional opera tive procedures to control infection: two pneumonectomies, three lobec tomies, three wedge resections, and two debridements of pulmonary absc ess were performed. Preoperative plain reentgenographs and computed to mographic scans diagnosed the empyema in all cases; however, they were frequently unable to predict the operative findings. There was one re currence and one mortality (4 percent). The average postoperative peri od of hospitalization was 18 days (seven to 30 days). CONCLUSIONS: Dec ortication remains a highly effective treatment for chronic postpneumo nic empyema and may identify underlying complications that could accou nt for a patient's poor response to conservative treatment. Pulmonary abscess and parenchymal necrosis may not be detected during preoperati ve evaluation.