Open-window thoracostomy in empyema thoracis: A retrospective review

Open-window thoracostomy offers a chance of treatment for cases of empyema thoracis not amenable for closed drainage or decortication. We review herein a collection of 12 cases based on our five years' experience in Kuala Lumpur Hospital, Malaysia performing this procedure.

Medical records of open-window thoracostomy cases performed from March 2018 till February 2023 were reviewed retrospectively. Data extracted included demographic information, indication for surgery, surgical approach, perioperative parameters, complications, and 18-months outcome. The primary end point for this study is sepsis resolution. Secondary endpoints are length of stay and spontaneous closure.

12 patients with mean age of 50.6 years underwent open-window thoracostomy. Five cases of empyema thoracis caused by bronchopleural fistula, five cases of destroyed lung and two recurrent empyema thoracis following unsuccessful decortication. All patients were extubated post-operatively except for two who required postoperative ventilatory support for two days. The primary end point was reached in all cases except one. Three complications were encountered in which blood loss exceeded 750mls.

Open-window thoracostomy may be performed safely in cases of empyema thoracis not amenable for closed drainage or decortication. Preoperative planning, preparation and counselling are vital to ensure good outcome and to manage patient's expectation.