LAUSR

Introduction: Pleural empyema is associated with considerable morbidity and mortality and its incidence seems to be rising in Western countries. Aim: To characterize patients with empyema who underwent thoracic surgery (TS) at our center. Methods: We reviewed the clinical data regarding to all patients submitted to TS due to empyema between 2014 and 2016. Statistical analysis was performed using Epi Info™7. Results: A total of 47 patients were operated (10 in 2014, 14 in 2015, 23 in 2016), most were male (70%, n=33) and median age was 49 years (min 19, max 89). Empyema was right sided in 23 cases (48%) and 2 were bilateral. Most infections were community acquired but 13 (27.7%) were associated with healthcare. Twenty one patients (44.7%) were successfully managed with VATS debridement and drainage. Four cases needed conversion to open surgery. The remaining (n=20) were managed with open thoracotomy and decortication. Median stay was 31 days (range 14-158) and it was longer in patients referred to the thoracic surgeon more than five days after admission (median 29 vs 44.5 days, p=0.017) and in those with nosocomial infections (median 28 vs 49 days, p=0.044). Open surgery related to longer hospital stays (median 44 vs 27 days, p=0.0037). The rate of serious complications was 14.9% (n=7) and 4 patients required reintervention. Most patients were discharged home, 3 (6.4%) were forward to the National Network of Integrated Continued Care and 5 (10.6%) died in hospital. Conclusions: In our sample the number of surgeries due to empyema increased over the years and we found an association between late referral to thoracic surgery and prolonged hospital stay. Overall, empyema remains a significant cause of morbidity and mortality.