Empyema thoracis in Nigerians: experience with a policy of conservative operative management

A combined retrospective and prospective review of 150 children and 28 adult Nigerian empyema thoracis patients was conducted between 1978 and 1986. Comorbidity requiring additional treatment was present in 145 patients (82.5%) while 175 patients (98.3%) had no, low or medium family income. In addition to medical management 161 out of 178 patients (90.4%) had tube thoracostomy while eight (4.4%) and seven (3.9%) respectively required additional minor and major thoracic procedures for failure of tube thoracostomy and arrest of, or failure to achieve, progressive pulmonary re-expansion and resolution of concomitant illness. Mean period of in-patient care was 30.5 days +/- 30.3. In spite of limitation of resources and poor clinical condition of most patients reduction of onset-diagnosis and diagnosis-treatment intervals and our overall management significantly reduced the perioperative mortality from 15.1% during the retrospective study period to 4.8% during the prospective period for a 9% overall perioperative mortality rate.