Decortication for chronic parapneumonic empyema: Results of a prospective study

Abstract. Despite advances in diagnostic methods, surgical techniques,
and supportive therapy, chronic parapneumonic empyema is still associated
with considerable morbidity and mortality. A prospective study was
performed on a consecutive series of patients with chronic parapneumonic
empyema to analyze the results of surgical treatment and identify clinical
predictors of poor outcome. From 1993 to 2000 a total of 40 patients underwent
decortication for chronic parapneumonic empyema. There was no
mortality. All 40 patients had definitive resolution of the empyema. Altogether,
34 patients (87.5%) had an uneventful postoperative course, and 5
(12.5%) experienced complications (2 prolonged febrile syndromes, 3 cases
of sepsis requiring mechanical respiratory assistance). All complications
resolved well with adequate treatment without further consequences. Definitive
results of the surgical procedures assessed at the 6-month follow-up
examination were good in 21 patients and satisfactory in 19. No unsatisfactory
results were observed in any of the patients. Univariate analysis
showed that three variables predicted morbidity: co-morbidities (p =
0.039), symptom duration ≥ 60 days (p=0.009), and duration of preoperative
conservative treatment ≥ 30 days (p = 0.006). Multivariate analysis
showed that only symptom duration ≥ 60 days (p = 0.041) and duration of
conservative treatment ≥ 30 days (p = 0.025) were associated with morbidity.
Decortication is a highly effective treatment for chronic parapneumonic
empyema and may be performed with low morbidity and mortality.
Because prolonged duration of symptoms and conservative treatment increase
morbidity, early surgical intervention seems to be the optimal modality
for the treatment of chronic parapneumonic empyema.