THE SURGICAL-MANAGEMENT OF EMPYEMA-THORACIS

Empyema thoracis remains a common thoracic problem with challenging ma nagement strategies. We analysed retrospectively 107 consecutive patie nts treated for empyema thoracic over a S-year period. The majority of patients (75%) were male with a mean age of 51 years. Common presenti ng symptoms were cough, dyspnoea, chest pain and pyrexia. The mean dur ation of pre-admission symptoms was 7.5 weeks. The causes of empyema w ere pneumonia, malignancy, iatrogenic injury and trauma. The most freq uently isolated organism was Streptococcus milleri. In 71% of patients there was an underlying systemic disorder. Forty-nine patients (46%) underwent an unsuccessful therapeutic procedure prior to admission to the surgical units. In the units, 24 patients received closed intercos tal chest tube drainage, 14 of whom required further intervention. Two patients were treated with repeated thoracocentesis. The majority of patients underwent a surgical procedure in the first instance: rib res ection and drainage (5), decortication (22), and more extensive proced ures (9) with only two patients requiring further surgery. The mean po st-operative stay was 16 days and the hospital mortality was 13%. We r ecommend early referral of all empyema patients to thoracic units, whe re assessment and definitive procedures can be performed with high cha nces of success and moderate risk of morbidity and mortality.