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Adjusting the RAPID score with 2 additional variables significantly increases its predictive value in patients with

B O Stüben1, G A Plitzko2, F Urban2

  • 1Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. stuebenb@me.com.

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This study identified new risk factors for pleural empyema surgery outcomes. Adding diabetes and renal replacement therapy to the RAPID score improved mortality prediction in surgical patients.

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Area of Science:

  • Thoracic Surgery
  • Critical Care Medicine
  • Clinical Risk Stratification

Background:

  • Pleural empyema necessitates lengthy hospitalizations, posing a significant healthcare burden.
  • Current treatments include antibiotics, chest tubes, and surgical interventions.
  • The RAPID score aids in identifying patients at risk of death.

Purpose of the Study:

  • To identify perioperative risk factors impacting pleural empyema surgical outcomes.
  • To assess if these factors improve upon the existing RAPID score for risk prediction.

Main Methods:

  • Retrospective analysis of 245 patients undergoing surgical treatment for pleural empyema.
  • Inclusion of patients receiving minimally invasive or open thoracic surgery.
  • Analysis of epidemiological and perioperative data to identify risk factors for 90-day mortality.

Main Results:

  • The 90-day mortality rate was 21.6%.
  • Diabetes, renal replacement therapy, immunosuppression, postoperative bleeding, intraoperative transfusion, and bacterial pleural invasion increased mortality.
  • The RAPID score predicted mortality; adding diabetes and renal replacement therapy enhanced its predictive value.

Conclusions:

  • Perioperative and patient-related factors not in the RAPID score negatively impact outcomes in surgically treated pleural empyema.
  • Consideration of these factors is crucial for treatment strategy.
  • Expanding the RAPID score may improve risk stratification for pleural empyema patients.