Abstract
Background: Video-assisted thoracoscopic surgery (VATS) is widely used for the treatment of empyema. We evaluated clinical symptoms, laboratory examinations, and thoracentesis to assess patients in the emergency department (ED) with empyema thoracis, undergoing VATS to identify predictors of adverse outcomes. Methods: This retrospective study was conducted by reviewing records of ED patients with pleural empyema admitted for VATS from January 2007 to June 2014. Demographic data, clinical symptoms, and laboratory examinations were compared for survivors (Group I) and non-survivors (Group II). Logistic regression analysis was used to identify parameters related to postoperative mortality. Results: From 380 patients, 7.6% (n = 29) died postoperatively. Survivors and non-survivors exhibited differences in age, gender, presence of cough, dyspnea, chest pain, empyema stage, cerebrovascular disease, malignancy, the glucose level of pleural fluid, serum hemoglobin, platelet count, blood urea nitrogen, and potassium levels. The logistic analysis demonstrated that the most significant factor related to the postoperative morbidity is chest pain (p = 0.018). Conclusions: VATS could be a safe option for pediatric and geriatric patients. Age does not appear to affect postoperative mortality. A high degree of awareness is essential for perioperative management and early surgical treatment when ED patients present with the clinical symptom of chest pain.
Highlights
Empyema thoracis is a collection of purulent fluid in the pleural space that mainly occurs with pneumonia or secondary to chest trauma/surgery
This study focused on patients presenting to the emergency department (ED) with suspected empyema thoracis
Our study indicated that comorbidity with cerebrovascular disease is related to mortality, whereas age or empyema stage was not a risk factor for mortality
Summary
Empyema thoracis is a collection of purulent fluid in the pleural space that mainly occurs with pneumonia or secondary to chest trauma/surgery. Half of the patients with pneumonia develop pleural effusion, and 5–10% of patients may develop empyema thoracis after antibiotic treatment [1]. Chest tube drainage, surgical intervention with video-assisted thoracoscopic surgery (VATS), or open thoracotomy. Laboratory examinations, and thoracentesis to assess patients in the emergency department (ED) with empyema thoracis, undergoing VATS to identify predictors of adverse outcomes. Survivors and non-survivors exhibited differences in age, gender, presence of cough, dyspnea, chest pain, empyema stage, cerebrovascular disease, malignancy, the glucose level of pleural fluid, serum hemoglobin, platelet count, blood urea nitrogen, and potassium levels. A high degree of awareness is essential for perioperative management and early surgical treatment when ED patients present with the clinical symptom of chest pain
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