Trends and practice patterns in the management of thoracic empyema

Background: This study explored the modern treatment of thoracic empyema. We evaluated outcomes of various operative approaches in both academic and nonacademic institutions. Methods:We queried the Society of Thoracic Surgeons National Database for patients undergoing thoracic procedures with a primary diagnosis of empyema between 2009 and 2011. We compared treatment outcomes of patients having procedures at academic (n=1101, 28.3%) and nonacademic (n=2790, 71.7%) medical centers. Results: Empyema treatments recorded in the database included tube thoracostomy (n=325, 8.4%), video-assisted thoracic surgery (n=1992, 51.2%), and thoracotomy (n=1574, 40.5%). Academic centers had higher rates of treatment by thoracostomy (13.8% vs. 6.2%), similar treatment rates of video-assisted thoracic surgery (49.9% vs. 51.7%), and lower rates of thoracotomy (36.3% vs. 42.1%) compared to nonacademic centers (p<0.001). Academic centers treated almost twice as many complicated empyemas with fistulas (11.4% vs. 6.5%, p<0.001). Postoperative length of stay was higher in the academic centers (interquartile range 5-13 vs. 4-11 days, p=0.001), while mechanical ventilation >48 h was more frequent in the nonacademic centers (7.6% vs. 4.4%, p=0.013). Conclusion: Surgeons in both academic and nonacademic centers use selective surgical approaches for treatment of thoracic empyema, depending on the clinical condition of the patient, with fairly equivalent results across all procedure types.