Video-Assisted Thoracoscopic Surgery in Community-Acquired Thoracic Empyema: Analysis of Risk Factors for Mortality

Abstract

Background:

Thoracic empyema is a disease with high mortality and morbidity. Video-assisted thoracoscopic surgery (VATS) is recommended to treat advanced stage empyema. The purpose of this study was to explore risk factors associated with post-surgery mortality for community-acquired empyema.

Patients and Methods:

We retrospectively reviewed 440 patients who received VATS for community-acquired empyema, higher than stage 2, in a tertiary medical center in Taiwan. Patients' age, comorbidities, pleural effusion analysis, and post-surgery outcome were compiled. Cox regression model for survival was applied to identify risk factors of 90-day death after surgery.

Results:

Fifty-three patients (12.05%) had died within 90 days post-surgery. The risk factors of mortality were advanced age (hazard ratio [HR], 1.027; 95% confidence interval [CI], 1.001–1.052), chronic kidney disease (HR, 5.322; 95% CI, 2.635–10.746), cancer (HR, 6.038; 95% CI, 2.737–13.321), pleural effusion pH ≤7 (HR, 2.61; 95% CI, 1.344–5.069), pleural effusion protein ≤4 (HR, 2.021; 95% CI, 1.035–3.947), and late surgery (HR, 3.014; 95% CI, 1.595–5.696). The 90-day mortality in the early surgery group versus the late group was 6.85% versus 26.05%. The increased mortality risk from late surgery was observed in most subgroups, except for patients who were female, had chronic renal disease, and had coronary artery disease.

Conclusions:

Patients who are elderly, have chronic kidney disease, cancer history, low pleural effusion pH, low pleural effusion protein, and late surgery are associated with post-surgery mortality for community-acquired advanced empyema. Early VATS surgery for advanced empyema or treatment failure of chest tube drainage appears to beneficial and is recommended.