Original articleGeneral thoracicChoice of First Intervention is Related to Outcomes in the Management of Empyema
Section snippets
Patients and Methods
The study (552-06-021, SC #3278) was approved without reservations by the Wright State University Institutional Review Board on March 22, 2007. Individual consent was waived for this retrospective record review. We examined hospital records from the VA Medical Center and Miami Valley Hospital between the years 2000 and 2006. Patients with empyema were identified by searching operating room databases, microbiology laboratory records, and discharge diagnoses.
To form a truly consecutive,
Results
We identified 106 consecutive patients with empyema. Two patients with ATS stage III empyema and fibrothorax were excluded from further analysis. The remaining 104 patients (85 men, 19 women) were aged 17 to 89 years. Smoking, alcohol abuse, multiple medical problems, poor performance status, and impaired nutrition characterized many of the patients. Most patients had clinically advanced empyema (Table 1).Table 2 provides the pleural culture results. Multiple organisms were identified, the
Comment
Although we recognize the limitations of a retrospective study, the results appear helpful in determining the best initial therapy for empyema. Our experience suggests strongly that early and aggressive management is best for most patients, especially those with empyema that is at a clinically advanced stage. These results are consistent with findings of numerous other studies suggesting the superiority of VATS or thoracotomy over simple drainage techniques [8, 9, 10, 11, 12].
Some have
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