Farjah Farhood, Symons Rebecca Gaston, Krishnadasan Bahirathan, Wood Douglas E, Flum David R
Division of General Surgery, Department of Surgery, University of Washington, Seattle, Wash 98195-6310, USA.
J Thorac Cardiovasc Surg. 2007 Feb;133(2):346-51. doi: 10.1016/j.jtcvs.2006.09.038. Epub 2006 Dec 29.
Management options for pleural space infections have changed over the last 2 decades. This study evaluated trends over time in the incidence of disease and use of different management strategies and their associated outcomes.
A retrospective study was performed by using a statewide administrative database of all hospitalizations for pleural space infections between 1987 and 2004.
Four thousand four hundred twenty-four patients (age, 57.1 +/- 18.6 years; 67% male; comorbidity index, 1.1 +/- 1.9) were hospitalized with pleural space infections. The incidence rate increased 2.8% per year (95% confidence interval, 2.2%-3.4%; P < .001). Overall, 51.6% of patients underwent an operation, and the proportion increased from 42.4% in 1987 to 58.4% in 2004 (P < .001). The risk of death within 30 days was less for patients undergoing operations compared with that for patients not undergoing operations (5.4% vs 16.6%, P < .001); however, patients undergoing operations were younger (52.9 +/- 17.6 years vs 61.5 +/- 18.6 years, P < .001) and had a lower comorbidity index (0.8 +/- 1.6 vs 1.4 +/- 2.1, P < .001). After adjusting for age, sex, comorbidity index, and insurance status, patients undergoing operative therapy had a 58% lower risk of death (odds ratio, 0.42; 95% confidence interval, 0.32-0.56; P < .001) than those undergoing nonoperative management.
The incidence of pleural space infections and the proportion of patients undergoing operative management have increased over time. Patients undergoing operations were younger and had less comorbid illness than those not undergoing operations but had a much lower risk of early death, even after adjusting for these factors.
在过去20年中，胸膜腔感染的管理方案发生了变化。本研究评估了疾病发病率、不同管理策略的使用情况及其相关结果随时间的变化趋势。
利用一个全州范围的行政数据库对1987年至2004年间所有因胸膜腔感染住院的患者进行了一项回顾性研究。
4424例患者（年龄57.1±18.6岁；67%为男性；合并症指数1.1±1.9）因胸膜腔感染住院。发病率每年增加2.8%（95%置信区间，2.2%-3.4%；P<.001）。总体而言，51.6%的患者接受了手术，这一比例从1987年的42.4%增至2004年的58.4%（P<.001）。与未接受手术的患者相比，接受手术的患者30天内死亡风险更低（5.4%对16.6%，P<.001）；然而，接受手术的患者更年轻（52.9±17.6岁对61.5±18.6岁，P<.001）且合并症指数更低（0.8±1.6对1.4±2.1，P<.001）。在对年龄、性别、合并症指数和保险状况进行调整后，接受手术治疗的患者死亡风险比接受非手术治疗的患者低58%（优势比，0.42；95%置信区间，0.32-0.56；P<.001）。
随着时间的推移，胸膜腔感染的发病率和接受手术治疗的患者比例有所增加。接受手术的患者比未接受手术的患者更年轻，合并症更少，但即使在对这些因素进行调整后，其早期死亡风险也低得多。
