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Related Experiment Videos

Is aggressive surgery in pleural empyema justified?

H Renner1, S Gabor, H Pinter

  • 1Department of Thoracic and Hyperbaric Surgery, University Medical School of Graz, Austria.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|October 1, 1998
PubMed
Summary

Aggressive surgery for pleural empyema offers rapid sepsis relief with low mortality, even in critically ill patients. This approach reduces hospitalization time, allowing patients to resume activities sooner.

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Area of Science:

  • Thoracic Surgery
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Pleural empyema management often involves concerns about high risk and prolonged hospitalization with aggressive surgical approaches.
  • Conservative treatments for pleural empyema can be unsuccessful, necessitating more invasive interventions.

Purpose of the Study:

  • To evaluate the outcomes and duration of hospitalization for patients with pleural empyema treated with an aggressive surgical schedule.
  • To assess the efficacy and safety of aggressive surgical intervention in severe pleural empyema cases.

Main Methods:

  • Retrospective analysis of 101 patients with pleural empyema treated since 1989.
  • Surgical interventions included thoracotomy (n=85), wedge resection/lobectomy/pneumonectomy (n=29), open-window thoracostomy (n=22), and drainage/irrigation (n=16).

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  • Patients presented with varying stages of empyema, including metapneumonic and post-traumatic/surgical, with many having failed prior conservative treatments or being critically ill.

    • Main Results:

    • The overall mortality rate was 3.9% (4/101 patients), with deaths attributed to sepsis or unrelated complications.
    • The median duration of hospitalization was 14 days (mean 21.1 days).
    • Most patients successfully resumed their preoperative activities following treatment.

    Conclusions:

    • Aggressive surgical management of pleural empyema, particularly beyond the seropurulent stage, effectively resolves sepsis.
    • This approach demonstrates a low mortality rate, even in critically ill patients with advanced empyema.
    • Aggressive surgery can lead to shorter hospitalization and successful patient recovery.