Ke-Cheng Chen1, Hsuan-Yu Chen2, Jou-Wei Lin3, Yu-Ting Tseng4, Shuenn-Wen Kuo5, Pei-Ming Huang5, Hsao-Hsun Hsu5, Jang-Ming Lee6, Jin-Shing Chen7, Hong-Shiee Lai8. 1. Institute of Biomedical Engineering, College of Engineering, National Taiwan University, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Dou-Liou, Taiwan; Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. 2. Institute of Statistical Science, Academia Sinica, Taipei, Taiwan. 3. Cardiovascular Center and Health Management Center, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Dou-Liou, Taiwan. 4. Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Dou-Liou, Taiwan. 5. Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. 6. Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: jangminglee@gmail.com. 7. Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Dou-Liou, Taiwan; Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: chenjs@ntu.edu.tw. 8. Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: hslai@ntu.edu.tw.
Abstract
BACKGROUND/ PURPOSE: Acute thoracic empyema is a common clinical problem worldwide, resulting in substantial morbidity and mortality. The objective of this study was to report its clinical characteristics and to evaluate whether thoracoscopic surgery is associated with a lower rate of in-hospital mortality compared with nonoperative drainage. METHODS: Between 2001 and 2010, we retrospectively reviewed the clinical characteristics, bacteriological studies, and treatment outcomes of 602 patients with acute thoracic empyema. Thoracoscopic surgery was performed in 417 (69.2%) patients, while the remaining patients underwent nonoperative drainage. After treatment, 77 patients (12.8%) died in the hospital. A propensity score-based process, matched on potential risk factors for in-hospital mortality, was performed to select patients with equalized potential prognostic factors in the thoracoscopy and nonoperative groups. The log-rank test was used to compare the survival time with discharge between the two matched groups. RESULTS: Multivariate analysis showed that age, malignancy, chronic lung disease, chronic renal insufficiency, liver cirrhosis, polymicrobial infection, and positive bacterial culture were risk factors for in-hospital mortality. The propensity score-matched analysis showed that the in-hospital mortality difference was significant (p = 0.014) and the Kaplan-Meier survival analysis revealed a higher survival rate to discharge (p < 0.001 by log-rank test), both favoring thoracoscopy over nonoperative drainage. CONCLUSION: Acute thoracic empyema carries a high mortality rate, especially in elderly patients with coexisting medical conditions and polymicrobial and positive bacterial cultures. Our study results also showed that thoracoscopy is feasible and might provide better chances for survival in borderline operable patients than nonoperative drainage.
BACKGROUND/ PURPOSE:Acute thoracic empyema is a common clinical problem worldwide, resulting in substantial morbidity and mortality. The objective of this study was to report its clinical characteristics and to evaluate whether thoracoscopic surgery is associated with a lower rate of in-hospital mortality compared with nonoperative drainage. METHODS: Between 2001 and 2010, we retrospectively reviewed the clinical characteristics, bacteriological studies, and treatment outcomes of 602 patients with acute thoracic empyema. Thoracoscopic surgery was performed in 417 (69.2%) patients, while the remaining patients underwent nonoperative drainage. After treatment, 77 patients (12.8%) died in the hospital. A propensity score-based process, matched on potential risk factors for in-hospital mortality, was performed to select patients with equalized potential prognostic factors in the thoracoscopy and nonoperative groups. The log-rank test was used to compare the survival time with discharge between the two matched groups. RESULTS: Multivariate analysis showed that age, malignancy, chronic lung disease, chronic renal insufficiency, liver cirrhosis, polymicrobial infection, and positive bacterial culture were risk factors for in-hospital mortality. The propensity score-matched analysis showed that the in-hospital mortality difference was significant (p = 0.014) and the Kaplan-Meier survival analysis revealed a higher survival rate to discharge (p < 0.001 by log-rank test), both favoring thoracoscopy over nonoperative drainage. CONCLUSION:Acute thoracic empyema carries a high mortality rate, especially in elderly patients with coexisting medical conditions and polymicrobial and positive bacterial cultures. Our study results also showed that thoracoscopy is feasible and might provide better chances for survival in borderline operable patients than nonoperative drainage.
Authors: Tamsin N Cargill; Maged Hassan; John P Corcoran; Elinor Harriss; Rachelle Asciak; Rachel M Mercer; David J McCracken; Eihab O Bedawi; Najib M Rahman Journal: Eur Respir J Date: 2019-10-01 Impact factor: 16.671
Authors: Galina Florova; René A Girard; Ali O Azghani; Krishna Sarva; Ann Buchanan; Sophia Karandashova; Christian J DeVera; Danna Morris; Mignote Chamiso; Kathleen Koenig; Douglas B Cines; Steven Idell; Andrey A Komissarov Journal: Physiol Rep Date: 2021-05
Authors: Hany Hasan Elsayed; Ahmed Mostafa; Essam Fathy; Haytham S Diab; Ibrahim Mostafa Nofal; Osama Abbas AbdelHamid; Hatem Yazeed El-Bawab; Ahmed A ElNori Journal: J Vis Surg Date: 2018-05-29