Minimally invasive surgery for pleural empyema: assessment of efficacy

Pleural empyema is know from ancient times, but still remains a serious problem in terms of morbidity and mortality. The aim of the study was to evaluate the efficacy of surgical treatment and to determine potential preoperative features that might help to predict conversion to open thoracotomy. There were 71 patients prospectively included in the study. All operations was started as video-assisted thoracic surgery (VATS), but in 25 % conversion to open thoracotomy was required. The time of illness (odds ratio (OR) 1.1 (95% confidence interval (CI) 1.0-1.2), p=0.004) and frank pus on aspiration (OR 4.4 (95% CI 1.2-15.3), p=0.021) were the only true preoperative independent predictors of conversion. Blood or pleural laboratory findings, radiological data or other preoperative clinical findings had no influence on conversion. The cut-off value for time of illness was 16 days (sensitivity 94.4%, specificity 54.7%). The time off illness was also associated with higher need of reoperation (7 of 8 patients who required re-do surgery where ill ≥ 16 days). Comorbidities and positive pleural culture were independent predictors of postoperative complications. Thoracoscopic and converted operations were equally effective, but conversion lasted longer, was associated with higher postoperative pain and higher postoperative Intensive Care Unit stay