| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1998;66:1121-1127
© 1998 The Society of Thoracic Surgeons
a Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
Address reprint requests to Dr Miller, Section of General Thoracic Surgery, 25 Prescott St, Suite 3420, Atlanta, GA 30345
Presented at the Thirty-fourth Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 26–28, 1998.
Abstract
Background. Empyema thoracis is treated with a multitude of therapeutic options. Optimal therapy and cost-containment requires selection of the most appropriate initial intervention.
Methods. A retrospective review of treatment modalities was performed on 77 patients diagnosed with empyema thoracis from 1990 to 1997 at one institution. Mean age was 59 years (range, 21 to 90 years); 52 were men and 25 were women.
Results. Sixty-five percent (50/77) were parapneumonic and 68% (52/77) were multiloculated. Treatment modalities were as follows: group 1, antibiotics only (n = 4); group 2, primary intervention: image-directed catheter (n = 20) or tube thoracostomy (n = 24); and group 3, secondary intervention: decortication (n = 17), rib resection or muscle interposition (n = 12). Thirty-four percent (9/20 image-directed catheter and 8/24 tube thoracostomy) had failure of initial intervention. Patients undergoing decortication more often had multiloculated empyema thoracis (16 of 17) compared with those undergoing image-directed catheters (8 of 20) or tube thoracotomy (16 of 24). Length of stay was reduced for decortication patients (17 days) compared with those having image-directed catheters (21.8 days), failed image-directed catheters (29.7 days), or tube thoracostomies (19.6 days). Hospital charges per patient between decortication and image-directed catheter ($34,770.79 versus $37,869.41) were comparable, but charges were significantly decreased in decortication patients as compared with failed image-directed catheters ($55,609.32; p < 0.05).
Conclusions. Our series revealed that early decortication has charges similar to those of primary intervention (image-directed catheter or tube thoracostomy) but is more cost-effective than failed image-directed catheter. We advocate the use of early surgical intervention as the most optimal and cost-effective initial modality for the treatment of empyema thoracis.
This article has been cited by other articles:
|
|
 |
|
  F. Farjah, R. G. Symons, B. Krishnadasan, D. E. Wood, and D. R. Flum Management of pleural space infections: A population-based analysis J. Thorac. Cardiovasc. Surg., February 1, 2007; 133(2): 346 - 351. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. A. Kurt, K. M. Winterhalter, R. H. Connors, B. W. Betz, and J. W. Winters Therapy of Parapneumonic Effusions in Children: Video-Assisted Thoracoscopic Surgery Versus Conventional Thoracostomy Drainage Pediatrics, September 1, 2006; 118(3): e547 - e553. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. H. Thourani, R. T. Lancaster, K. A. Mansour, and J. I. Miller Jr Twenty-six years of experience with the modified eloesser flap Ann. Thorac. Surg., August 1, 2003; 76(2): 401 - 406. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. R. Roberts Minimally invasive surgery in the treatment of empyema: intraoperative decision making Ann. Thorac. Surg., July 1, 2003; 76(1): 225 - 230. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Riquet, J.-P. Hubsch, and A. Chehab Treatment modalities for thoracic empyema: the right indication for the right disease Ann. Thorac. Surg., June 1, 1999; 67(6): 1829 - 1829. [Full Text] [PDF]
|
|
|
|
|
|
V. H. Thourani and J. I. Miller Jr Reply Ann. Thorac. Surg., June 1, 1999; 67(6): 1829 - 1830. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
