Comparison of outcomes between primary and secondary lung decortication

With the view to compare the outcomes between primary and secondary lung decortication, we examined all the patients admitted with empyema thoracis in our unit. The primary decortication was defined as a primary procedure, without prior attempt of pleural space evacuation with either chest tube or previous decortication. Secondary decortication was defined as a failed lung re-expansion after initial pleural space drainage or failed primary decortication. Anecdotally, secondary decortication is associated with increased complications and length of hospital stay. From literature search, there is currently no study that directly compared outcomes of these two procedures; hence, the rationale to conduct this study.

All patients presented to our unit with empyema thoracis from 1^st January 2011-31^st December 2014, were included in a retrospective quantitative descriptive study. A total number of 160 patients were analyzed and eighty patients underwent each of the procedures (primary and secondary decortication). A comparison of prospective outcomes of the two groups was made. Fisher Exact test was used to compare percentages including the rates of complications between primary and secondary decortication. Mean values were compared using the t-test. The frequencies of other variables were also determined.

There was significant statistical difference in the length of hospital stay (ICU and Ward) and between patients who underwent primary as opposed to secondary decortication. The frequencies of complications (chest wall abscess, recurrent empyema, wound sepsis and wound dehiscence) were higher for secondary decortication, but without statistical significance. There was significant statistical difference in terms of age, CD4 count (only for HIV patients) and Adenosine deaminase (ADA) between patients who underwent primary instead of secondary decortication.

The patient who underwent secondary lung decortication had a more prolonged hospital stay than those who had primary decortication. There were increased frequencies of complication in secondary decortication group, though without statistical significant difference (P=0.456). The patients who underwent secondary decortication had poor nutritional state compared to those who had primary decortication, with significant statistical difference (P=0.0370).