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EVALUATION OF DELAY IN DEFINITIVE SURGICAL MANAGEMENT OF EMPYEMA

Northwestern, Chicago, IL

PURPOSE: Options for management of thoracic empyema include antibiotic therapy, thoracentesis, tube thoracostomy, intrapleural fibrinolytics, video-assisted thoracic surgery (VATS), and open thoracotomy. Delay in optimal care results in poor outcomes and longer hospital stay. We would like to characterize delays in treatment and outcomes of definitive surgical intervention for patients with empyema.

METHODS: Retrospective review of 37 patients treated for empyema between April 2003 and November 2006 at a tertiary care center. Diagnosis of empyema was based on standard combinations of pleural fluid cultures, pH, radiologic features, and/or purulent material observed during intervention. The primary outcome measure was based on length of hospital stay (LOS, measured in days). Positive outcome was defined as LOS ; 14 days; negative outcome was defined as LOS 15 days. Time to definitive treatment (TDT) was defined as the number of days from admission to either VATS or open thoracotomy.

RESULTS: There were 26 males (mean age 50.1, range 21-82) and 11 females (mean age 58.0, range 19-82), with a total of 41 hospitalizations. Of these hospitalizations, 18 (43.9%) had a positive outcome and 23 (56.1%) had a negative outcome. Of hospitalizations with positive outcomes, 13/18 required definitive treatment (average TDT 1.7 days) and their average LOS was 9.8 days. Of the hospitalizations with negative outcomes, 14/23 required definitive treatment (average TDT 6.5 days) and their average LOS was 33.5 days. Shorter TDT was associated with a shorter LOS (p<0.002).

CONCLUSION: Positive outcomes for empyema patients, as defined in this study, are associated with early surgical intervention and fewer preoperative interventions such as thoracentesis, chest tubes, and fibrinolytics. Delayed definitive treatment resulted in longer hospital stays and tended to occur in patients with negative cultures or in patients given less aggressive treatment such as multiple antibiotics, thoracentesis, chest tubes, and/or fibrinolytics.

CLINICAL IMPLICATIONS: In these complex patients, early thoracic surgery consultation will likely shorten TDT and thus improve outcome.

DISCLOSURE: Martin Martin, No Financial Disclosure Information; No Product/Research Disclosure Information