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Eur J Cardiothorac Surg 2005;27:32-34
© 2005 Elsevier Science NL

Continuous pleural lavage may decrease postoperative morbidity in patients undergoing thoracotomy for stage 2 thoracic empyema

Heart Center, Tampere University Hospital, Tampere University, 33521 Tampere, Finland

Received 21 June 2004; received in revised form 30 September 2004; accepted 4 October 2004.

^* Corresponding author. Tel.: +358 3 3116 4945; fax: +358 3 2475756. (E-mail: ari.mennander{at}pshp.fi).

Objective: To assess the impact of postoperative continuous pleural lavage (PCPL) after thoracotomy for the treatment of stage 2 pleural empyema in relation to postoperative length of stay and morbidity. Methods: Stage 2 pleural empyema was diagnosed with computer tomography. Conservative treatment including antibiotics and pleural aspiration was introduced. 89 patients treated for stage 2 pleural empyema by thoracotomy, pleural discharge evacuation and irrigation after pleural decortication were identified after unsuccessful conservative treatment for 10 days. Whenever pleural discharge remained opaque after operation, PCPL was administered daily through the cranial chest tube and discharge evacuated through the caudal pleural suction (10–15mmHg) tube. Risk factors related to pleural pus and patient outcome were sought for. Results: Seventy-seven out of 89 patients (86.5%) had clear empyema discharge immediately after pleural decortication and irrigation. Pleural discharge remained opaque despite surgery in 12 out of 89 patients (13.5%) and PCPL was introduced. Presence of a combination of risk factors for pleural empyema, such as dental caries, alcohol abuse or previous inflammatory reaction, was predictive for persistence of opaque pleural discharge after operation (P<0.05). Need for re-thoracotomies (in 11 cases, P=ns) and postoperative deaths (P<0.05) were related with patients who did not have PCPL. The length of the hospital treatment was 20.1±3.1 (days±SEM) among patients with PCPL and 19.2±1.8 without PCPL before possible re-thoracotomy, respectively (P=ns). Conclusions: Early postoperative (1 day–11 months) mortality was statistically associated with patients having fibrinopurulent empyema but no PCPL. PCPL is a feasible method to clear pleural pus discharge without prolongation of hospitalization and may be recommended after thoracotomy for patients with fibrinopurulent stage 2 empyema.

Key Words: Pleural empyema • Lavage • Morbidity