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Published on: October 25, 2024
224
Empyema Secondary to Pneumonia: Whom Should We Operate?
Daniel Lichtenstein1, Vadim Smolyakov2, Yael Refaely3
1Department of Thoracic Surgery, Kaplan Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Rehovot, Israel.
Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
|February 1, 2024
Summary
Younger patients with pneumonia-related empyema often require surgery. Surgical intervention improves long-term survival, regardless of age, and is linked to factors like fluid density on CT scans.
Area of Science:
- Thoracic Surgery
- Pulmonology
- Medical Imaging
Background:
- Empyema secondary to pneumonia is a frequent clinical challenge.
- A substantial proportion of patients necessitate surgical intervention for effective management.
- Identifying predictors for surgical intervention is crucial for optimizing patient care.
Purpose of the Study:
- To identify predictive factors associated with the need for surgical intervention in patients with empyema secondary to pneumonia.
- To evaluate the impact of surgical intervention on long-term survival.
- To explore the correlation between radiological findings and the requirement for surgery.
Main Methods:
- Retrospective analysis of medical records from 2010-2019.
- Inclusion of 194 patients diagnosed with empyema secondary to pneumonia.
- Categorization into surgical (Group A) and nonoperative (Group B) treatment groups.
- Collection of clinical, laboratory, and chest computerized tomography (CT) data.
Main Results:
- Younger age, higher systolic blood pressure, and elevated white blood count were significant predictors of surgical intervention.
- Multivariate analysis confirmed younger age as a significant factor for operative intervention (aOR=0.971, P=.023).
- Surgical intervention correlated with increased survival (aHR=1.762, P=.046), and older age correlated with decreased survival (aHR=0.050, P<.001).
- Higher empyema fluid density on CT scans was observed in the surgical group (4.3 HU higher, P<.067).
Conclusions:
- Younger age is associated with a higher likelihood of surgical intervention in pneumonia-related empyema.
- Surgical intervention is linked to improved long-term survival, independent of patient age.
- Radiological features such as empyema fluid density, pleural thickening, and loculations may predict the need for surgery.
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