EARLY AGGRESSIVE SURGICAL-MANAGEMENT OF PARAPNEUMONIC EMPYEMAS

We have analyzed our experience with 90 consecutive patients who were operated on for parapneumonic empyema between 1981 and 1992. Patients whose empyema did not resolve with chest tube drainage were taken to t he operating room. Nineteen patients had limited thoracotomy and drain age. Seventy-one patients had formal thoracotomy, debridement, pleurec tomy, and decortication. We found that an age greater than 60 years, c ardiac disease, end-stage renal disease, end-stage bronchitis, prolong ed tube drainage, and immunosuppression are associated with increased morbidity and mortality. In those patients who do not respond well to a short course of chest tube drainage, we recommend early aggressive s urgical approach, including formal thoracotomy and definitive treatmen t. This allowed for early discharge from the hospital without chest tu bes or open draining wounds. In extremely ill patients, limited thorac otomy may be all that is safe or possible and usually suffices.