MANAGEMENT OF EMPYEMA: OUR EXPERIENCE

Arjun Saxena, Abhishek Tiwari

Abstract


Aim: The management of empyema depends upon the stage of the disease. Video-assisted thoracoscopic surgery (VATS) can be done in intermediate fibrinopurulant stage, but difficult in organized stage. We evaluated the importance of early referral to the higher center, so that more patients can get the benefits of VATS.

Material and Methods: We performed a retrospective review case sheets of the patients diagnosed with empyema in our hospital, admitted in our hospital between December 2006 and December 2017. Age of the patients ranged from 3 years to 16 years. We analyzed demography, pus culture sensitivity, radio-diagnosis reports, treatment strategy, ICU stay, total hospital stay, complications and final outcome.

Results: 241 patients with empyema were managed through the study period in our department.  Sixty (37.7%) patients out of those (159) who were referred with chest tube from other hospitals have got greater duration of fever before admission to our hospital, and lesser patients (28.33%) underwent VATS. The patients referred without chest tube (99), were also having almost same rate of undergoing VATS. The patients (82) admitted primarily in our hospital, have got more rate of undergoing VATS (41.46%). Mean duration of fever before admission to our hospital was least (11+2 days) in patients, who were admitted primarily in our hospital and decision for surgical intervention taken earlier. Median length of hospital stay was least with VATS (6 days).

Conclusion: Although the patients in our study were not randomized, according to treatment strategy, but results indicate that as far as the surgical management is concerned, early referral to higher center with a facility of VATS is very important. It reduces the hospital stay, ICY stay and overall cost of the treatment.

Keywords


Empyema, VATS, Video-assisted thoracoscopic surgery, thoracotomy, decortication, Pleural empyema

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