A randomized trial of empyema therapy

Michael A. Wait, Sashi Sharma, Joyce Hohn, Anthony Dal Nogare

Research output: Contribution to journalArticle

265 Citations (Scopus)

Abstract

Study objectives: To determine the optimal treatment of empyema thoracis (within the fibrinopurulent phase of illness) comparing pleural drainage and fibrinolytic therapy vs video-assisted thoracoscopic surgery (VATS), with regard to efficacy and duration of hospitalization. Design: Twenty patients with confirmed parapneumonic empyema thoracis were randomized to chest tube pleural drainage plus streptokinase (CT-SK) vs VATS. Setting: University- based teaching hospital providing for Dallas County. Patients and methods: Equivalent groups of patients with parapneumonic empyema thoracis were randomized to receive either of two therapies: CT-SK (n=9) or VATS (n= 11). Outcomes analysis with respect to treatment efficacy, hospital duration, chest tube duration, hospital costs, and need for subsequent procedures was performed. Results: Each group suffered one mortality (p=not significant). When compared with the CT-SK group, the VATS group had a significantly higher primary treatment success [10/11, 91% vs 4/9, 44%; p<0.05 Fisher's Exact Test], lower chest tube duration (5.8±1.1 vs 9.8±1.3 days; p=0.13), and lower number of total hospital days (8.7±0.9 vs 12.8± 1.1 days; p=0.009). Clinically relevant but not statistically significant differences in hospital costs ($16,642±2,841 vs $24,052±3,466, p =0.11) also favored the VATS group. Of note, all the CT-SK treatment failures could be salvaged with VATS, and none required thoracotomy. Conclusions: In patients with loculated, complex fibrinopurulent parapneumonic empyema thoracis, a primary treatment strategy of VATS is associated with a higher efficacy, shorter hospital duration, and less cost than a treatment strategy that utilizes catheter- directed fibrinolytic therapy.

Original languageEnglish (US)
Pages (from-to)1548-1551
Number of pages4
JournalChest
Volume111
Issue number6
StatePublished - 1997

Fingerprint

Video-Assisted Thoracic Surgery
Empyema
Chest Tubes
Hospital Costs
Thrombolytic Therapy
Therapeutics
Drainage
Streptokinase
Thoracotomy
Treatment Failure
Teaching Hospitals
Health Care Costs
Hospitalization
Catheters
Mortality

Keywords

  • Empyema
  • Streptokinase
  • VATS

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Wait, M. A., Sharma, S., Hohn, J., & Dal Nogare, A. (1997). A randomized trial of empyema therapy. Chest, 111(6), 1548-1551.

A randomized trial of empyema therapy. / Wait, Michael A.; Sharma, Sashi; Hohn, Joyce; Dal Nogare, Anthony.

In: Chest, Vol. 111, No. 6, 1997, p. 1548-1551.

Research output: Contribution to journalArticle

Wait, MA, Sharma, S, Hohn, J & Dal Nogare, A 1997, 'A randomized trial of empyema therapy', Chest, vol. 111, no. 6, pp. 1548-1551.
Wait MA, Sharma S, Hohn J, Dal Nogare A. A randomized trial of empyema therapy. Chest. 1997;111(6):1548-1551.
Wait, Michael A. ; Sharma, Sashi ; Hohn, Joyce ; Dal Nogare, Anthony. / A randomized trial of empyema therapy. In: Chest. 1997 ; Vol. 111, No. 6. pp. 1548-1551.
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AB - Study objectives: To determine the optimal treatment of empyema thoracis (within the fibrinopurulent phase of illness) comparing pleural drainage and fibrinolytic therapy vs video-assisted thoracoscopic surgery (VATS), with regard to efficacy and duration of hospitalization. Design: Twenty patients with confirmed parapneumonic empyema thoracis were randomized to chest tube pleural drainage plus streptokinase (CT-SK) vs VATS. Setting: University- based teaching hospital providing for Dallas County. Patients and methods: Equivalent groups of patients with parapneumonic empyema thoracis were randomized to receive either of two therapies: CT-SK (n=9) or VATS (n= 11). Outcomes analysis with respect to treatment efficacy, hospital duration, chest tube duration, hospital costs, and need for subsequent procedures was performed. Results: Each group suffered one mortality (p=not significant). When compared with the CT-SK group, the VATS group had a significantly higher primary treatment success [10/11, 91% vs 4/9, 44%; p<0.05 Fisher's Exact Test], lower chest tube duration (5.8±1.1 vs 9.8±1.3 days; p=0.13), and lower number of total hospital days (8.7±0.9 vs 12.8± 1.1 days; p=0.009). Clinically relevant but not statistically significant differences in hospital costs ($16,642±2,841 vs $24,052±3,466, p =0.11) also favored the VATS group. Of note, all the CT-SK treatment failures could be salvaged with VATS, and none required thoracotomy. Conclusions: In patients with loculated, complex fibrinopurulent parapneumonic empyema thoracis, a primary treatment strategy of VATS is associated with a higher efficacy, shorter hospital duration, and less cost than a treatment strategy that utilizes catheter- directed fibrinolytic therapy.

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