Surgical management of thoracic empyema-5 years review

Introduction: Empyema associates with high morbidity/mortality, thus early diagnosis and treatment are essential. Chest tube drainage is recommended in early-stage II empyema. In stage II multiloculated and stage III, surgery is the first-line approach. Objectives: Characterize patients submitted to surgery for empyema. Methods: A retrospective analysis of patients with empyema submitted to surgery in 2015-20. Results: 56 patients were included, 75% of males and a mean age of 52±16 years. Empyema occurred on the right side in 55.4%. Pneumonia was the main cause (78.6%), followed by chest trauma (14.3%). Microbiology of pleural fluid identified the agent in 15 patients (26.8%), being pneumococcus and MSSA the most frequent. 79% of patients were first submitted to drainage and later to surgery at a median of 12 days after (IQR 8-21). 91% of patients had stage III and 9% had stage II empyema at the time of surgery. Video-assisted thoracoscopic surgery was the preferred surgical method (98.2%). Complications occurred in 21 patients, mostly in stage III (95%), being the most frequent prolonged air leak (30%) and wound dehiscence (7%). Chest tube was removed at post-operative day (POD) 5 (IQR 4-8) and patients were sent home at POD 9 (IQR 7-14). 2 patients needed a subsequent procedure for persistence of pleural infection and 2 needed readmission at 90 days. In-hospital mortality was 3.6%. Conclusions: In this series, as described in literature, the most common form of empyema was parapneumonic, caused by gram-positive bacteria. Patients were submitted to surgery in advanced stages, which can explain the high complication rate. There is a need for early surgery to reduce hospital stay, chest tube use duration and complications.