Video-Assisted Thoracoscopic Surgery of Parapneumonic Empyema – a 10-year Single-Centre Experience

Abstract

Objectives Evaluation of a standardised management for the treatment of patients with parapneumonic empyema.

Methods A retrospective 10-year single-centre analysis of all patients with parapneumonic empyema undergoing a standardised thoracoscopic treatment approach. We describe referral and age patterns, microbiological results, overall and stage-dependent success rates, conversion rates, 30-day and in-hospital mortality.

Results From May 2003 to April 2013, 248 patients with parapneumonic empyemas were treated in our centre. Most patients were referred at weekends, and younger patients had advanced stages. The cure rate in stage I was 97.6 % and reached 80.3 % in stage II and 63.1 % in stage III. 6 patients (2.4 %) (all stage III) needed conversion to an open procedure. A revision was required in 19.7 % of cases in stage II and 27.7 % in stage III. 30-day mortality was 4.8 %, in-hospital mortality was 8.1 %.

Conclusion A standardised approach, including VATS, is associated with a high cure, low revision and moderate conversion rates. In view of a still considerable mortality, a higher index of suspicion and detection of advanced stages, especially in younger patients, is required to improve outcomes.

Zusammenfassung

Ziel der Studie Auswertung einer standardisierten Behandlungsstrategie für Patienten mit parapneumonischen Empyemen.

Methoden Retrospektive Analyse von 248 Patienten mit einem parapneumonischen Empyem während eines 10-Jahres-Zeitraumes in einem Thoraxzentrum.

Ergebnisse Von Mai 2003 bis April 2013 wurden insgesamt 248 Patienten mit parapneumonischen Empyemen operativ versorgt. Die meisten Patienten wurden an Wochenenden, speziell freitags, aufgenommen, und jüngere Patienten wiesen fortgeschrittene Stadien auf. Im Stadium I betrug die Erfolgsquote 97,6 %, im Stadium II 80,3 % und im Stadium III 63,1 %. Bei 6 Patienten (2,4 %) in Stadium III war eine Konversion auf ein offenes Vorgehen erforderlich. Eine Revision erfolgte bei 19,7 % aller Fälle im Stadium II und in 27,7 % der Fälle im Stadium III. Die 30-Tage-Letalität betrug 4,8 %, die Krankenhaus-Letalität 8,1 %.

Schlussfolgerungen Ein standardisiertes Vorgehen durch VATS ist verbunden mit einer hohen Erfolgsquote und einer niedrigen Konversions- und moderaten Revisionsrate. Angesichts einer erheblichen Letalität ist eine frühere Diagnostik zur Verbesserung der Ergebnisse erforderlich, insbesondere bei jüngeren Patienten.

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