Predicting factors for outcome of tube thoracostomy in complicated parapneumonic effusion or empyema

Study objectives: To determine the predicting factors for outcome of tube t horacostomy in patients with complicated parapneumonic effusion (CPE) or em pyema. Design, and settings: Retrospective chart review over a 55-month period at a tertiary referred medical center. Patients and measurements: The medical charts of patients with empyema or C PE were reviewed. Data including age, gender, clinical symptoms, important underlying diseases, leukocyte count, duration of preadmission symptoms, in terval from first procedure to second procedure, the time from first proced ure to discharge (recovery time), the amount of effusion drained, administr ation of intrapleural streptokinase, chest tube size and position, loculati on of pleural effusion, and characteristics and culture results of pleural effusion were recorded and compared between groups of patients with success ful and failed outcome of tube thoracostomy drainage. Results: One hundred twenty-one patients were selected for study. One hundr ed of these patients had received tube thoracostomy drainage with 53 succes sful outcomes and 47 failed outcomes of chest tube drainage. Nineteen patie nts received decortication directly, and the other two received antibiotics alone. Univariate analysis showed that pleural effusion leukocyte count, e ffusion amount, and loculation of pleural effusion were significantly relat ed to the outcome of chest tube drainage. Multiple logistic regression anal ysis demonstrated that loculation and pleural effusion leukocyte count less than or equal to 6,400/mu L were the only independent predicting factors r elated to failure of tube thoracostomy drainage. Conclusions: Loculation and pleural effusion leukocyte count less than or e qual to 6,400/mu L were independent predicting factors of poor outcome of t ube thoracostomy drainage. These results suggest that if the initial attemp t at chest tube drainage fails, early surgical intervention should be consi dered in good surgical candidates with loculated empyema or pleural effusio n with leukocyte count less than or equal to 6,400/mu L.