Empyema in adults and children: difference in surgical approaches, report of 139 cases

• Published in: Acta chirurgica belgica Vol. 107; no. 2; p. 187
• Main Authors: Nadir, A, Kaptanoglu, M, Gonlugur, U, Cevit, O, Sahin, E, Akkurt, I
• Format: Journal Article
• Language: English
• Published: England 2007
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Drainage - statistics & numerical data; Empyema, Pleural - epidemiology; Empyema, Pleural - etiology; Empyema, Pleural - therapy; Female; Fibrinolytic Agents - therapeutic use; Humans; Infant; Male; Middle Aged; Pneumonia, Bacterial - complications; Postoperative Complications; Retrospective Studies; Thoracoplasty - statistics & numerical data; Thoracostomy - statistics & numerical data; Turkey - epidemiology; Turkey
• ISSN: 0001-5458
• DOI: 10.1080/00015458.2007.11680038

We investigated specific aetiology and different therapeutic approaches in patients with empyema in a General Thoracic Surgery Clinic. Charts of 139 patients admitted with empyema, between January 1998 and March 2005 were retrospectively reviewed. Although not completely comparable, patients were divided into two groups; Paediatric (n = 71) and adult (n = 68) cases. In addition to demographic characteristics, treatment options, complications and clinical outcomes were investigated according to the specific group. The mean age was 5.6 years (4 mo - 17 y) for paediatric patients and 49.6 years (20-81 y) for adult patients. Overall, 65% of the patients (n = 91) were male. All paediatric cases had parapneumonic empyema, while 63% of the adult cases had parapneumonic and 23.5% had postoperative empyema. Of the paediatric cases, 50% received fibrinolytic treatment in addition to tube thoracostomy and 35% had decortication. In adults, 42% had tube thoracostomy and fibrinolytic treatment, and decortication was required in 9% only. Thoracomyoplasty was performed in 12% of the patients (n = 8). We had no mortality in paediatric patients, however mortality rate was 8% in the adult group. Morbidity, consisted mostly of prolonged air leakage and impaired lung expansion. Early decortication and fibrinolytic treatment are sufficient for paediatric patients, while a variety of techniques including open drainage, rib resection and thoracomyoplasty are required in adult patients with empyema.