Incidence, Length of Stay, and Prognosis of Hospitalized Patients With Pleural Empyema

Søgaard, Mette; Nielsen, Marie Germund; Nørgaard, Mette; Kornum, Jette Brommann; Schønheyder, Henrik Carl; Thomsen, Reimar Wernich

doi:10.1378/chest.13-1912

Cited by 66 publications

(77 citation statements)

References 5 publications

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“…1,4,7,29 Urea separate from creatinine has also been shown in our study to be an important predictor of mortality. Both urea and age within the CURB65 predictive model have prognostic roles in pneumonia, 30 but CURB65 has not been shown to be useful as a prognostication tool in pleural infection.…”

Section: Discussionsupporting

confidence: 78%

“…Similarly, we need to question the possibility of increased virulence for pleural infection in Pacific people. Like others, [1][2][3][4][5][6][7][8]10,11 our study has shown a disproportionate number of males, which others have not been able to explain in the past. This again highlights the possibility of an underlying gender/ genetic susceptibility to pleural infection.…”

Section: Discussionsupporting

confidence: 60%

“…4,6 These morbid outcomes vary from prolonged hospital stay to invasive surgical interventions and mortality rates of up to 20%, 1,7 all of which are associated with significant healthcare cost.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pleural infection in a New Zealand centre: high incidence in Pacific people and RAPID score as a prognostic tool

Wong

Yap

2016

Internal Medicine Journal

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Section: Discussionsupporting

confidence: 78%

Section: Discussionsupporting

confidence: 60%

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Pleural infection in a New Zealand centre: high incidence in Pacific people and RAPID score as a prognostic tool

Wong

Yap

2016

Internal Medicine Journal

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“…The average length of hospitalization varies from 5.7 to 18.5 days, but is significantly longer if VATS fails or if complications occur (3,6,8,9,17,(32)(33)(34). Postoperative stay, as stated by Waller and colleagues, is significantly longer in the conversion group vs the successfully done VATS group (8.5 and 5.5 days) (19).…”

Section: Discussionmentioning

confidence: 95%

Video-assisted thoracic surgery in pleural empyema: predictors of complications and treatment failures

Jagelavičius¹,

Jovaišas²,

Matačiūnas³

et al. 2015

AML

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Background. Empyema remains a challenging entity for thoracic surgeons. The aim of this study was to evaluate preoperative predictors for unsuccessful thoracoscopic empyemectomy and postoperative complications.Materials and methods. There were 71 patients prospectively included in the study during the period from January 2011 to June 2014 in whom we performed thoracoscopic empyemectomy. Two main outcomes were evaluated: conversion and complications. Preoperative factors that could predict these outcomes were analyzed.Results. Conversion to open thoracotomy was required in 25.4% of cases. Fourteen (19.7%) patients had postoperative complications. The multivariate analysis showed that the time of illness (odds ratio 1.1; confidence interval 1.1-1.2), normal temperature on admission (odds ratio 11.2; confidence interval 1.5-85.4) and frank pus found on thoracocentesis (odds ratio 6.9; confidence interval 1.6-29.4) had a significant influence on conversion from thoracoscopy to open thoracotomy. Pain (odds ratio 0.01; confidence interval <0.01-0.6), subfebrile temperature on admission (odds ratio 10.1; confidence interval 1.4-73.5), positive pleural culture (odds ratio 8.5; confidence interval 1.0-70.1), Charlson comorbidity index (odds ratio 2.3; confidence interval 1.1-4.8), empyema volume (odds ratio 1.002; confidence interval 1.000-1.005) and empyema density (odds ratio 0.8; confidence interval 0.6-1.0) had a significant influence on postoperative complications.Conclusions. Longer time of illness, normal temperature on admission and frank pus in pleural aspiration increase probability of conversion. No pain, subfebrile temperature, higher Charlson comorbidity index on admission, positive pleural culture, higher volume and lower density of empyema on computed tomography scan increase probability of postoperative complications.

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“…The average length of hospitalization in the literature varies from 5.7 to 18.5 days but usually is significantly longer if VATS fails or if complications occur [3,4,7,16,25,28,29]. Postoperative stay, as stated by Waller and Rengarajan, is significantly longer in the conversion group than in the successfully done VATS group (8.5 and 5.5 days) [18].…”

Section: Discussionmentioning

confidence: 99%

Preoperative predictors of conversion in thoracoscopic surgery for pleural empyema†

Jagelavičius

Jovaišas

Matačiūnas

et al. 2017

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES: Thoracoscopy is an effective treatment method for pleural empyema; however, it is still not well defined as to which patient subgroups could benefit from it the most. The aim of the study was to identify preoperative factors that could facilitate selecting appropriate surgical intervention and to evaluate early postoperative period. METHODS:Seventy-one patients were prospectively included in the study, which was conducted from January 2011 to June 2014. Thoracoscopic surgery for Stage II/III pleural empyema was performed in all patients. Thoracoscopy failed in 18 (25.4%) patients, requiring conversion to thoracotomy. The preoperative factors that could possibly predict conversion were analysed.RESULTS: Obliterated pleural space (12 patients) and failure to achieve lung re-expansion (6 patients) were the main reasons for conversion. Multivariable logistic regression analysis demonstrated that each day of illness [odds ratio 1.1 (95% confidence interval 1.0-1.2], P = 0.004] and frank pus [odds ratio 4.4 (95% confidence interval 1.2-15.3), P = 0.021] were independent predictors of conversion. Using receiver-operating characteristic analysis, it was determined that the duration of illness had a high predictive value for conversion [area under the curve 0.8 (95% confidence interval 0.7-0.9), P < 0.001]. The cut-off value for duration of illness was 16 days (sensitivity 94.4%, specificity 54.7%). The conversion group had a significantly greater need for postoperative intensive care unit stay (P = 0.022) but a lower rate of reoperations (P = 0.105).CONCLUSIONS: Duration of illness and frank pus discovered during thoracocentesis can help in selecting the patient for appropriate intervention. Earlier surgery for pleural empyema can reduce the rate of conversion and reoperation.

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Incidence, Length of Stay, and Prognosis of Hospitalized Patients With Pleural Empyema

Cited by 66 publications

References 5 publications

Pleural infection in a New Zealand centre: high incidence in Pacific people and RAPID score as a prognostic tool

Pleural infection in a New Zealand centre: high incidence in Pacific people and RAPID score as a prognostic tool

Video-assisted thoracic surgery in pleural empyema: predictors of complications and treatment failures

Preoperative predictors of conversion in thoracoscopic surgery for pleural empyema†

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