HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Renner, H. Articles by Smolle-Juettner, F.M. Search for Related Content PubMed PubMed Citation Articles by Renner, H. Articles by Smolle-Juettner, F.M.

Eur J Cardiothorac Surg 1998;14:117-122
© 1998 Elsevier Science NL

Is aggressive surgery in pleural empyema justified?¹

Department of Thoracic and Hyperbaric Surgery, University Medical School of Graz, A-8036 Auenbruggerplatz 29, Graz, Austria

Received 29 September 1997; received in revised form 14 April 1998; accepted 13 May 1998.

Corresponding author. Tel.: +43 316 385–2803; fax: +43 316 385–2756.

Objective: High risk and a long hospitalization time are often quoted as negative aspects of aggressive surgery in pleural empyema. We did a retrospective analysis evaluating outcome and duration of hospitalization in patients treated according to an aggressive schedule. Methods: Since 1989 we have treated 101 patients with pleural empyema (72 males, 29 females; mean age 50.3 years, range 11–91 years; 77 metapneumonic empyema, 24 empyema following trauma or abdominal surgery). Sixty-nine patients had had unsuccessful conservative pre-treatment (antibiotics, thorcozentses, drainage/irrigation, VATS). Thirty-one were critically ill patients. In eight cases a seropurulent stage of empyema was present, 17 patients had fibrinous membranes, 30 an organizing stage with and 46 without well identifiable dissection plane. Eighty-five patients proceeded to thoracotomy. Pulmonary abscesses or indurative pneumonia necessitated wedge-resection, lobectomy, or pneumonectomy in 29 cases. In the presence of gross necroses or callosities not amenable to decortication primary open-window thoracostomy (n=22) was carried out. In six cases a secondary open-window thoracostomy was carried out because of persisting putrid secretion and sepsis persisting after decortication or after drainage. The thoracostomy was closed when clean granulative tissue developed. Sixteen patients underwent only drainage and irrigation because of an early stage or because of a general condition not permitting thoracotomy. Results: Three patients died due to severe sepsis not responding to treatment, one had fatal bleeding from a duodenal ulcer (mortality rate 3.9%). The others were able to resume their preoperative activities. The median duration of hospitalization was 14 days (mean 21.1 days; SEM 1.7 days). Conclusion: Aggressive surgery for pleural empyema beyond the seropurulent stage ensures rapid relief from sepsis at a low mortality rate even in very ill patients.

Key Words: Pleural empyema • Decortication • Hospitalization time

This article has been cited by other articles:

				K. M. Al-Kattan Management of tuberculous empyema Eur. J. Cardiothorac. Surg., March 1, 2000; 17(3): 251 - 254. [Abstract] [Full Text] [PDF]