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Management of refractory empyema with early decortication
A Muskett1, N A Burton, S V Karwande
1Division of Cardiothoracic Surgery, University of Utah Medical School, Salt Lake City 84132.
American Journal of Surgery
|December 1, 1988
Summary
Early surgical intervention for empyema, specifically thoracotomy and decortication, effectively treats difficult pleural infections. This approach leads to good patient outcomes with acceptable hospital stays and low complication rates.
Area of Science:
- Thoracic Surgery
- Infectious Diseases
- Pulmonary Medicine
Background:
- Empyema, a serious pleural infection, often requires surgical intervention.
- Causes include pneumonia, trauma, and abdominal sepsis.
- Loculated empyema may necessitate advanced imaging for diagnosis.
Purpose of the Study:
- To evaluate the outcomes of surgical procedures for empyema.
- To assess the efficacy of early thoracotomy and decortication.
- To determine morbidity and mortality rates associated with empyema treatment.
Main Methods:
- Retrospective analysis of 100 consecutive patients undergoing empyema surgery.
- Utilization of CT and ultrasonography for loculated empyema.
- Surgical interventions included thoracotomy with decortication, rib resection, and Eloesser flap.
Main Results:
- 85% of patients achieved excellent results with a 4% recurrence rate.
- Postoperative 30-day mortality was 6%, in-hospital mortality was 9%.
- Overall morbidity rate was 17%.
Conclusions:
- Early thoracotomy and decortication are effective in eradicating complex pleural infections.
- The procedure offers acceptable hospital stays with manageable morbidity and mortality.
- Gram-positive aerobes were common, alongside opportunistic infections.