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Ann Thorac Surg. 2019 Jul 26. pii: S0003-4975(19)31059-8. doi: 10.1016/j.athoracsur.2019.05.090. [Epub ahead of print]

Outcomes of Operative and Non-Operative Treatment of Thoracic Empyema: A Population Based Study.

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Department of Surgery, Queen's University. Electronic address:
Department of Surgery, Queen's University.
Institute of Clinical Evaluative Sciences (ICES) Queen's, Queen's University.
Department of Medicine, Queen's University.



The optimal management of thoracic empyema remains unclear. This study aimed to compare mortality and readmission risk following operative versus non-operative treatment of thoracic empyema.


Administrative universal healthcare data were used to conduct a retrospective population-based cohort study of thoracic empyema in Ontario, Canada. Individuals ≥18 years of age with a hospital discharge diagnosis of thoracic empyema from January 1, 1996 to December 31, 2015 were included. Treatment approach was classified as non-operative (i.e. chest tube +/- fibrinolytics) or operative (video assisted thoracoscopic surgery (VATS) or open decortication). Modified Poisson regression was used to estimate adjusted risk ratios (RRadj) between treatment (open decortication was the reference group) and 1) mortality and 2) readmission. Analyses were also stratified by year of admission in 5-year intervals.


9,014 hospitalized individuals were included in the study cohort. Individuals treated non-operatively had higher mortality risk as an inpatient 17.2% vs. 10.6% (RRadj 1.32-1.54), at 30 days 11.1% vs. 4.2% (RRadj 1.86-3.38), six months 26.6% vs. 15.0% (RRadj 1.38-1.59) and one year 32.3% vs. 18.8% (RRadj 1.38-1.59). No differences in 90-day readmission risk were observed. No effect measure modification was observed in models stratified by year of admission.


Non-operative management of thoracic empyema was associated with higher risk of mortality compared with surgical decortication. Early thoracic surgical consultation is recommended.

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