Complicated pleural infection treated with enzyme therapy prior to surgery was associated with significantly lower 90-day mortality

SESSION TITLE: Complicated Pleural Effusions SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/10/2023 12:55 pm - 01:44 pm PURPOSE: Pleural infection is associated with a 90- day mortality as high as 20%. While simple pleural infection can be managed with percutaneous drainage, the historical definitive treatment for complicated pleural infection (cPI) has been surgery. In a prospective randomized controlled trial, Rahman et al., demonstrated improved patient outcomes with intrapleural enzyme therapy (IET, tPA and DNase) for the treatment of cPI. While prior studies have attempted to compare IET to surgery, no study has specifically compared the outcomes of cPI treated with IET prior to surgery versus surgery alone. METHODS: We identified 298 patients with cPI all treated with IET prior to surgery and compared them to 225 patients with cPI all treated with initial surgery. IET patients were derived from a multicenter, international database, and surgery-only patients were from one large quaternary care center in Hamburg, Germany. Patient demographics, RAPID score components and other factors known to be associated with increased surgical mortality were evaluated as confounders. RESULTS: 90-day mortality for patients receiving IET prior to surgery was found to be significantly lower than those treated with upfront surgery (8.4% vs. 22.7%, p<0.0001, OR 3.2, 95% CI 1.9 - 5.4). In addition, patients in the IET first cohort were younger (53 vs 62), had higher albumin levels (2.7 mg/dL vs 1.7 mg/dL) and were less immunosuppressed (7% vs 25%). Both groups had similar rates of diabetes (20% vs 17%). CONCLUSIONS: Intrapleural enzyme therapy prior to surgery for cPI may be associated with lower 90-day mortality than upfront surgery alone. Further analysis of these data and prospective trials are needed to expand on and validate these findings. CLINICAL IMPLICATIONS: Rather than being an alternative to surgery, IET may be beneficial when used in conjunction with surgery for cPI. DISCLOSURES: No relevant relationships by Jason Akulian No relevant relationships by Maxwell Diddams No relevant relationships by Björn-Ole Stüben