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J Thorac Cardiovasc Surg. 2013 Apr;145(4):933-939.e1. doi: 10.1016/j.jtcvs.2012.07.035. Epub 2012 Aug 25.

Surgical decortication as the first-line treatment for pleural empyema.

Author information

1
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
2
Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
3
Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Gangnam Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
4
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea. Electronic address: littmann@yuhs.ac.

Abstract

OBJECTIVE:

The study objective was to evaluate the clinical outcomes of surgical decortication as the first line of treatment for pleural empyema.

METHODS:

We analyzed the medical records of 111 patients who presented with empyema and were treated with simple drainage or surgical decortication as the first line of treatment at Gangnam Severance Hospital, a tertiary referral medical center in Seoul, Korea.

RESULTS:

Of 111 patients with empyema, 27 underwent surgical decortication as the first intervention. Surgical decortication showed a better treatment success rate in all study subjects (96.3%, 26/27 patients) compared with simple drainage (58.3%, 49/84 patients; P < .0001 for method comparison). After propensity-scored matching, decortication resulted in a better outcome (95.0%, 19/20 patients) versus drainage (56.7%, 17/30 patients; P = .003). Surgical decortication as the first line of treatment for empyema was the best predictor of treatment success after adjustment for compounding factors (odds ratio, 14.529; 95% confidence interval, 1.715-123.074; P = .014).

CONCLUSIONS:

The first treatment choice for pleural empyema is a critical determinant of ultimate therapeutic success. After adjusting for confounding variables, surgical decortication is the optimal first treatment choice for advanced empyema.

PMID:
22929218
DOI:
10.1016/j.jtcvs.2012.07.035
[Indexed for MEDLINE]
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