Early Thoracotomy and Decortication in Pleural Empyema

Background and aim Pleural empyema remains a serious complication of pulmonary infections, with high morbidity and mortality if not managed effectively. While antibiotics and drainage are sufficient in the early stages, chronic empyema often requires surgical intervention. This study evaluates the outcomes of early thoracotomy and decortication for pleural empyema at a tertiary cardiac center in India. Methods A retrospective observational study was conducted on nine patients who underwent early thoracotomy and decortication between 2018 and 2024. Demographics, radiological findings, etiology, complications, survival, and follow-up outcomes were analyzed. Survival and event-free survival were assessed using the Kaplan-Meier method. Results Six patients were female (66.7%), and three were male (33.3%). Four patients underwent right-sided, four left-sided, and one bilateral decortication. Six patients (66.7%) had moderate pleural fluid, three (33.3%) had large fluid collections, and all nine (100%) had pleural thickening ≥2 cm. Etiologies included non-tuberculosis (TB; n = 7; 77.8%) and TB (n = 2; 22.2%). Postoperative complications occurred in three patients (33.3%), including prolonged air leak (n = 2) and superficial wound infection (n = 1). One patient (11.1%) died from nosocomial pneumonia, acute respiratory distress syndrome, and septic shock. Kaplan-Meier estimated survival probability was 88.9% at 30 days and remained stable at 12 months. Event-free survival at 12 months was 66.7%. The median hospital stay was 12 days (range, 8-21). All survivors demonstrated satisfactory lung re-expansion with no recurrence during three to 12 months of follow-up. Conclusions Early thoracotomy and decortication is a safe and effective treatment for advanced-stage pleural empyema, yielding favorable survival and functional outcomes. Despite advances in minimally invasive surgery, thoracotomy remains indispensable for selected patients, particularly in TB-endemic regions.