Reducing Air Leak After Empyema Surgery: COPD's Role and Patient Management

Despite medical advancements, the rise in pleural empyemas persists in the United States. Surgical decortication for pleural empyema subjects patients to the potential complication of a prolonged air leak (PAL). This study aims to uncover the incidence, predictors, and outcomes of PAL following surgical decortication for pleural empyemas within a single tertiary institution.

Patients who underwent surgical decortication for plural empyema between 2011 and 2021 were identified in our single tertiary institution and divided into two groups: PAL and no PAL. Preoperative characteristics and postoperative outcomes were compared, and the results of the descriptive univariate analyses were reported.

Among the 228 patients who met inclusion criteria, 7.5% undergoing surgical decortication for pleural empyema were diagnosed with PAL. While demographic differences were not significant between PAL and no PAL groups, PAL patients showed higher chronic obstructive pulmonary disease prevalence (82.4% versus 34.1%, P < 0.001) and lifetime tobacco use. PAL cases had increased rates of reoperation (29.4% versus 8.1%, P = 0.015) and remained intubated at the conclusion of the case.

Patients with chronic obstructive pulmonary disease were significantly more likely to develop PAL, which is associated with higher rates of reoperation and extended hospital stays. These findings underscore the importance of preoperative identification of high-risk patients and the implementation of targeted preventive measures to improve surgical and postoperative outcomes, thereby reducing morbidity and healthcare costs.