Study objective: We evaluated treatment and outcome of patients with t
horacic empyema at a teaching institution. Design and setting: Retrosp
ective chart review over a 44-month period at a university hospital. P
atients and measurements: Charts of patients with a hospital discharge
diagnosis of thoracic empyema were reviewed. Age, symptoms, alcohol u
se, empyema etiology, culture results, number of loculations, date and
success of each procedure, length of hospital stay, and hospital disc
harge status were recorded for each patient. Success of procedure, rec
overy time, time between procedures, and total hospitalization time we
re compared between procedures and between subgroups. Results: Charts
from 43 patients were reviewed. Twenty-four of 43 (56%) cases were par
apneumonic empyemas. Forty of 43 (93%) patients had symptoms attributa
ble to their empyema, with fever being the most common (65%). Seventy-
nine procedures were needed to treat the 43 patients (1.84 procedures
per patient). Success rates ranged from 11% (3/27) for tube thoracosto
my to 95% (21/22) for decortication (p=0.0001). Delay between procedur
es averaged 6.2+/-1.1 (mean+/-SEM) days between the first and second p
rocedure (n=27), and 10.4+/-5.1 days between the second and third proc
edure (n=8). Mean recovery after successful intervention ranged from 9
to 19.3 days depending on the procedure (p=NS). Comparisons between m
ultiloculated and uniloculated empyemas, parapneumonic and nonparapneu
monic empyemas, and culture proven and biochemically proven empyemas s
howed no significant difference in procedure success rates or length o
f hospital stay. Conclusion: Multiple therapeutic options exist for th
e treatment of thoracic empyema. Optimal therapy requires selection of
the most appropriate first procedure for each patient with early post
procedure imaging to avoid inordinate delays between interventions.