Morbidity and mortality after 94 extrapleural pneumonectomies for empyema

Background. Extrapleural pneumonectomy is still indicated in some patients with empyema. We examined morbidity and mortality after this high-risk oper ation. Methods. Between 1979 and 1998, 94 (92 chronic, 2 postsurgical) patients wi th empyema underwent extrapleural pneumonectomy. There were 79 men and 15 w omen (mean age, 59 years). Eighty-eight patients had a history of tuberculo sis, and 53 had undergone a therapeutic pneumothorax. The right side was op erated on in 50 patients and left in 44. Results. Operative mortality was 8.5%. Fifteen major complications (1 esoph ageal perforation, 9 empyemas, and 5 bronchopleural fistulas) occurred in 1 3 patients. Eight patients required reexploration for hemorrhage. Reexplora tion was a risk factor for empyema. Bronchopleural fistulas occurred only o n the right side. Eighty-nine percent of the 86 operative survivors were fr ee of empyemas at 5 years. Overall 5-year survival was 83%, and survival wa s better in patients without than in those with empyema. Conclusions. Extrapleural pneumonectomy for empyema has acceptable morbidit y and mortality. Postoperative empyema affects prognosis. Covering: a bronc hial stump with muscle is recommended, especially when the operation is per formed on the right side. (C) 2000 by The Society of Thoracic Surgeons.