Thoracotomy and decortication: impact of culture-positive empyema on the outcome of surgery

Coltart, Cordelia E M; Billè, Andrea; Guile, Lucy; Pilling, John; Harrison-Phipps, Karen; Routledge, Tom; Lang-Lazdunski, Loı̈c; Hemsley, Carolyn; King, Juliet

doi:10.1093/ejcts/ezu104

Cited by 24 publications

(32 citation statements)

References 16 publications

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“…The mean length of stay was postoperative 12.8 days and overall 18.7 days. These data are comparable with the current literature (2,3,5,14). Complications occurred in 21%, mortality was 5.25%, whereas the first is also well comparable with the values in literature, the second one is slightly lower.…”

Section: Discussionsupporting

confidence: 91%

“…Surgical treatment of advanced parapneumonic empyema is widely accepted [14]. There is current literature focusing on minimal-invasive thoracic surgery and on the identification of clinical predictors to operate successfully with thoracoscopic surgery to avoid thoracotomy and therefore major thoracic surgery (5,11,12).…”

Section: Discussionmentioning

confidence: 99%

“…There is current literature focusing on minimal-invasive thoracic surgery and on the identification of clinical predictors to operate successfully with thoracoscopic surgery to avoid thoracotomy and therefore major thoracic surgery (5,11,12). However, advanced parapneumonic empyema still often needs thoracotomy for complete pleural decortication (4,5,13,14). Current literature quotes a mean postoperative length of stay between 8 and 20 days in cases of thoracotomy due to empyema.…”

Section: Discussionmentioning

confidence: 99%

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Procalcitonin as preoperative marker for surgery in advanced parapneumonic empyema

et al. 2017

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Background: The optimal time point for surgical management of advanced parapneumonic empyema in need of open pleurectomy and decortication remains unclear. We hypothesized that surgical outcomes will be better when procalcitonin (PCT) levels have dropped to normal ranges as evidence for resolution of the underlying pneumonia. Results for postoperative length of stay were similar. Eight patients in the pPCT ≥0.25 μg/L group had postoperative complications with two deaths while no complications occurred in the PCT <0.25 μg/L group (38% vs. 0%, P=0.004).Conclusions: These data suggest better surgical outcomes in advanced parapneumonic empyema when pneumonia has resolved with a pPCT drop of <0.25 μg/L. A larger, prospective study is needed to confirm these results.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Procalcitonin as preoperative marker for surgery in advanced parapneumonic empyema

et al. 2017

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“…Lardinois and colleagues stated that only Gram-negative bacteria significantly increased the rate of conversion but in general the positive culture had no influence on conversion (25). On the other hand, according to our data and to the Okiror and colleagues study (31), the positive culture significantly increased the risk of postoperative complications.…”

Section: Discussionsupporting

confidence: 60%

“…Clinically it may provide better clues for the decision to perform the early surgical approach. The positive culture from the pleural space is assessed by different authors in 10-60% of patients (5,6,8,15,24,25,(28)(29)(30)(31)(32). Such a low percentage of positive cultures may represent an effective antibiotic treatment prior to sample collection.…”

Section: Discussionmentioning

confidence: 99%

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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Medical and Surgical Management of Empyema

Godfrey

Bramley

Detterbeck

2019

Semin Respir Crit Care Med

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Infection of the pleural space is an ancient and common clinical problem, the incidence which is on the rise. Advances in therapy now present clinicians of varying disciplines with an array of therapeutic options ranging from thoracentesis and chest tube drainage (with or without intrapleural fibrinolytic therapies) to video-assisted thoracic surgery (VATS) or thoracotomy. A framework is provided to guide decision making, which involves weighing multiple factors (clinical history and presentation, imaging characteristics, comorbidities); multidisciplinary collaboration and active management are needed as the clinical course over a few days determines subsequent refinement. The initial choice of antibiotics depends on whether the empyema is community-acquired or nosocomial, and clinicians must recognize that culture results often do not reflect the full disease process. Antibiotics alone are rarely successful and can be justified only in specific circumstances. Early drainage with or without intrapleural fibrinolytics is usually required. This is successful in most patients; however, when surgical decortication is needed, clear benefit and low physiologic impact are more likely with early intervention, expeditious escalation of interventions, and care at a center experienced with VATS.

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Thoracotomy and decortication: impact of culture-positive empyema on the outcome of surgery

Abstract: T/D is safe and achieved lung re-expansion in the majority of patients. Culture-positive empyema was associated with worse outcomes.

Cited by 24 publications

References 16 publications

Procalcitonin as preoperative marker for surgery in advanced parapneumonic empyema

Procalcitonin as preoperative marker for surgery in advanced parapneumonic empyema

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

Medical and Surgical Management of Empyema

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