Management of late-stage parapneumonic empyema

Li Ern Chen, Jacob C. Langer, Patrick A. Dillon, Robert P. Foglia, Charles B. Huddleston, Eric N. Mendeloff, Robert K. Minkes

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Purpose: Despite the reported value of early video-assisted thoracoscopic surgery (VATS) for empyema, many children are still referred to the surgeon late in the disease process. The authors wished to determine the optimal management strategy for this group of children. Methods: Medical records of all children (n = 70) from 1990 to 2000 with late-presenting empyema (stage II of III) were reviewed. Patients were grouped as (G1) successful management with chest tube (CT), (G2) surgery after initial CT, (G3) thoracentesis followed by surgery, and (G4) surgery alone. Results: There were no significant differences with respect to age, gender, pleural cultures or fluid analysis. Fifty-one (73%) patients required surgical intervention. Treatment using CT (G1, G2) or thoracentesis (G3) was associated with prolonged length of stay (LOS) when compared with surgery alone (G4; 12 v 8 days). For G2, G3, and G4, rapid clinical improvement and early discharge (6 days) was seen after surgery. For all surgery groups (G2, G3, G4), video-assisted thoracoscopic surgery (n = 19) was associated with a longer postoperative fever (4 v 2 days; P < .05), but a shorter total LOS (12 v 15 days; P < .05) when compared with open decortication (n = 32). Conclusions: Over 70% of children with late presenting empyema required surgery, including more than half of the children who received initial chest tube drainage. Delay in surgery was associated with more procedures, more radiographs, and an increased LOS. Despite later intervention, patients undergoing surgery as an initial approach had the shortest length of stay. Early surgical intervention is indicated for most children referred with established empyema.

Original languageEnglish (US)
Pages (from-to)371-374
Number of pages4
JournalJournal of Pediatric Surgery
Volume37
Issue number3
DOIs
StatePublished - 2002

Fingerprint

Empyema
Chest Tubes
Length of Stay
Video-Assisted Thoracic Surgery
Medical Records
Drainage
Fever

Keywords

  • Decortication
  • Empyema
  • Parapneumonic
  • VATS

ASJC Scopus subject areas

  • Surgery

Cite this

Chen, L. E., Langer, J. C., Dillon, P. A., Foglia, R. P., Huddleston, C. B., Mendeloff, E. N., & Minkes, R. K. (2002). Management of late-stage parapneumonic empyema. Journal of Pediatric Surgery, 37(3), 371-374. https://doi.org/10.1053/jpsu.2002.30828

Management of late-stage parapneumonic empyema. / Chen, Li Ern; Langer, Jacob C.; Dillon, Patrick A.; Foglia, Robert P.; Huddleston, Charles B.; Mendeloff, Eric N.; Minkes, Robert K.

In: Journal of Pediatric Surgery, Vol. 37, No. 3, 2002, p. 371-374.

Research output: Contribution to journalArticle

Chen, LE, Langer, JC, Dillon, PA, Foglia, RP, Huddleston, CB, Mendeloff, EN & Minkes, RK 2002, 'Management of late-stage parapneumonic empyema', Journal of Pediatric Surgery, vol. 37, no. 3, pp. 371-374. https://doi.org/10.1053/jpsu.2002.30828
Chen LE, Langer JC, Dillon PA, Foglia RP, Huddleston CB, Mendeloff EN et al. Management of late-stage parapneumonic empyema. Journal of Pediatric Surgery. 2002;37(3):371-374. https://doi.org/10.1053/jpsu.2002.30828
Chen, Li Ern ; Langer, Jacob C. ; Dillon, Patrick A. ; Foglia, Robert P. ; Huddleston, Charles B. ; Mendeloff, Eric N. ; Minkes, Robert K. / Management of late-stage parapneumonic empyema. In: Journal of Pediatric Surgery. 2002 ; Vol. 37, No. 3. pp. 371-374.
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AU - Mendeloff, Eric N.

AU - Minkes, Robert K.

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N2 - Purpose: Despite the reported value of early video-assisted thoracoscopic surgery (VATS) for empyema, many children are still referred to the surgeon late in the disease process. The authors wished to determine the optimal management strategy for this group of children. Methods: Medical records of all children (n = 70) from 1990 to 2000 with late-presenting empyema (stage II of III) were reviewed. Patients were grouped as (G1) successful management with chest tube (CT), (G2) surgery after initial CT, (G3) thoracentesis followed by surgery, and (G4) surgery alone. Results: There were no significant differences with respect to age, gender, pleural cultures or fluid analysis. Fifty-one (73%) patients required surgical intervention. Treatment using CT (G1, G2) or thoracentesis (G3) was associated with prolonged length of stay (LOS) when compared with surgery alone (G4; 12 v 8 days). For G2, G3, and G4, rapid clinical improvement and early discharge (6 days) was seen after surgery. For all surgery groups (G2, G3, G4), video-assisted thoracoscopic surgery (n = 19) was associated with a longer postoperative fever (4 v 2 days; P < .05), but a shorter total LOS (12 v 15 days; P < .05) when compared with open decortication (n = 32). Conclusions: Over 70% of children with late presenting empyema required surgery, including more than half of the children who received initial chest tube drainage. Delay in surgery was associated with more procedures, more radiographs, and an increased LOS. Despite later intervention, patients undergoing surgery as an initial approach had the shortest length of stay. Early surgical intervention is indicated for most children referred with established empyema.

AB - Purpose: Despite the reported value of early video-assisted thoracoscopic surgery (VATS) for empyema, many children are still referred to the surgeon late in the disease process. The authors wished to determine the optimal management strategy for this group of children. Methods: Medical records of all children (n = 70) from 1990 to 2000 with late-presenting empyema (stage II of III) were reviewed. Patients were grouped as (G1) successful management with chest tube (CT), (G2) surgery after initial CT, (G3) thoracentesis followed by surgery, and (G4) surgery alone. Results: There were no significant differences with respect to age, gender, pleural cultures or fluid analysis. Fifty-one (73%) patients required surgical intervention. Treatment using CT (G1, G2) or thoracentesis (G3) was associated with prolonged length of stay (LOS) when compared with surgery alone (G4; 12 v 8 days). For G2, G3, and G4, rapid clinical improvement and early discharge (6 days) was seen after surgery. For all surgery groups (G2, G3, G4), video-assisted thoracoscopic surgery (n = 19) was associated with a longer postoperative fever (4 v 2 days; P < .05), but a shorter total LOS (12 v 15 days; P < .05) when compared with open decortication (n = 32). Conclusions: Over 70% of children with late presenting empyema required surgery, including more than half of the children who received initial chest tube drainage. Delay in surgery was associated with more procedures, more radiographs, and an increased LOS. Despite later intervention, patients undergoing surgery as an initial approach had the shortest length of stay. Early surgical intervention is indicated for most children referred with established empyema.

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