EMPYEMA-THORACIS - THERAPEUTIC MANAGEMENT AND OUTCOME

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.