|Title:||Acute thoracic empyema: Clinical characteristics and outcome analysis of video-assisted thoracoscopic surgery||Authors:||Chen K.-C.
|Issue Date:||2014||Publisher:||Elsevier Ltd||Journal Volume:||113||Journal Issue:||4||Start page/Pages:||210-218||Source:||Journal of the Formosan Medical Association||Abstract:||
Background/Purpose: Acute thoracic empyema is a common clinical problem worldwide, resulting in substantial morbidity and mortality. The objective of this study was to report its clinical characteristics and to evaluate whether thoracoscopic surgery is associated with a lower rate of in-hospital mortality compared with nonoperative drainage. Methods: Between 2001 and 2010, we retrospectively reviewed the clinical characteristics, bacteriological studies, and treatment outcomes of 602 patients with acute thoracic empyema. Thoracoscopic surgery was performed in 417 (69.2%) patients, while the remaining patients underwent nonoperative drainage. After treatment, 77 patients (12.8%) died in the hospital. A propensity score-based process, matched on potential risk factors for in-hospital mortality, was performed to select patients with equalized potential prognostic factors in the thoracoscopy and nonoperative groups. The log-rank test was used to compare the survival time with discharge between the two matched groups. Results: Multivariate analysis showed that age, malignancy, chronic lung disease, chronic renal insufficiency, liver cirrhosis, polymicrobial infection, and positive bacterial culture were risk factors for in-hospital mortality. The propensity score-matched analysis showed that the in-hospital mortality difference was significant (p=0.014) and the Kaplan-Meier survival analysis revealed a higher survival rate to discharge (p<0.001 by log-rank test), both favoring thoracoscopy over nonoperative drainage. Conclusion: Acute thoracic empyema carries a high mortality rate, especially in elderly patients with coexisting medical conditions and polymicrobial and positive bacterial cultures. Our study results also showed that thoracoscopy is feasible and might provide better chances for survival in borderline operable patients than nonoperative drainage. ? 2014.
|ISSN:||0929-6646||DOI:||10.1016/j.jfma.2013.12.010||metadata.dc.subject.other:||acute disease; acute thoracic empyema; adult; article; bacterium culture; chronic kidney failure; chronic lung disease; clinical evaluation; controlled study; empyema; female; human; infection; liver cirrhosis; major clinical study; male; malignant neoplastic disease; microbiological examination; middle aged; mortality; outcome assessment; prognosis; propensity score; risk factor; survival rate; survival time; thoracoscopy; thorax drainage; treatment outcome; video assisted thoracoscopic surgery; aged; Empyema, Pleural; mortality; retrospective study; Acute Disease; Adult; Aged; Empyema, Pleural; Female; Hospital Mortality; Humans; Male; Middle Aged; Propensity Score; Retrospective Studies; Thoracic Surgery, Video-Assisted
|Appears in Collections:||醫學系|
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