Characteristics of medically and surgically treated empyema patients: a retrospective cohort study.

Background: The role of drainage, intrapleural fibrinolytics, and/or surgery in the management of thoracic empyema is controversial. Objectives: We aimed to investigate the operational practice of empyema management at our hospital. Methods: Between January 2001 and December 2008, all patients with thoracic empyema were retrieved. After exclusion of patients with malignant effusion, traumatic or iatrogenic empyema, and a history of pleurodesis or tuberculosis, we compared the characteristics of medically versus surgically treated empyema patients. Results: Seventy-eight of 215 retrieved patients were acute bacterial empyema cases. All received intravenous antibiotics. Fifty-eight (74.4%) initially received tube thoracostomy, 34 (43.6%) were treated with intrapleural urokinase, and 30 (38.5%) were operated on. Of 20 patients without initial tube thoracostomy, 15 (75%) were operated on, compared to 9 (37.5%) who were initially treated by tube thoracostomy without intrapleural fibrinolytics (OR 5; 95% CI 1.4–18.5, p = 0.01) and 6 (17.7%)