Empyema thoracis: Is treatment outcome procedure dependent?

Abstract

The study was a 10 years retrospective study between January 1990 and December 1999. A total of 224 patients were managed for empyema thoracis in surgical and non surgical wards of Kenyatta National Hospital (KNH), during the study period. The commonest cause of empyema thoracis was post pneumonic (39.3%) with pulmonary tuberculosis being a close second (38.8%). The rarest aetiological factor was thoracotomy and represented 0.5% of all empyema thoracis during the study period. Men were affected more than females at a ratio of 1:2.5. Four primary procedures (the first procedure carried out after the patient was admitted) were studied: thoracentesis, tube drainage, rib resection and thoracotomy and decortication. The commonest procedure was closed tube drainage which was used as a primary procedure in 164 patients (73.2%) followed by decortication (15.6%), thoracentesis (8.5%) and rib resection (2.7%). The cure rates achieved by procedures were dependent, among other factors, on the stage and aetiology of empyema. However, thoracotomy and decortication achieved the highest overall cure rate (82%) followed by thoracentesis (78.9%). Rib resection and tube drainage achieved 66.7% and 61% overall cure rates respectively. Analysing cure rates by stage of empyema showed thoracentesis to have achieved the highest cure rates in stage I (88.2%) and decortication the highest cure rates in both stage II and III (100% and 82% respectively). Post thoracotomy empyema carried the highest overall cure rate (100%) and the empyema secondary to malignancy carried the 'lowest cure rate, with none of the patients with the diagnosis-achieving cure. Complications were encountered in 66 patients or 29.5% of all the patients treated. Of the procedures associated with complications, tube drainage recorded the highest number of complications (49/66 or 74.2% of all complications). However, this represented only 29.9% (491164) of all patients treated using tube drainage. Tube drainage carried a lower complication rate than decortication (12135 or 34.3%). Thoracentesis recorded the lowest complication rate (5.2%). An overall mortality of 17.9% was recorded with the highest mortality being noted in the tube drainage group (20.1 %) followed by decortication (17.1 %), thoracentesis (5.3%) and none of the patients dying after rib resection. Thoracotomy and decortication carried the longest duration. of hospital stay with a mean of 19.8 days (range 6-57 days) and the shortest was thoracentesis (mean 7.75 days and range 1-19 days