Empyema thoracis: a review of a 4 1/2 year experience of cases requiring surgical treatment.

During the period January 1985 to June 1989, 53 cases of empyema thoracis were treated surgically at Papworth hospital regional cardio-thoracic centre. Of these, 47 patients underwent thoracotomy and decortication as their primary surgical treatment. The remaining six patients were treated by rib resection. Prior to surgical referral 20 of these had undergone previous tube drainage for a mean period of 18 days (range 7-42 days). The principle cause of empyema was broncho-pulmonary infection. In 57% of cases no organisms were isolated from pleural debris or fluid. In the remainder, a variety of organisms were encountered. Early surgical drainage and freeing of the underlying lung met with good results and no deaths in the uncomplicated group. The median duration of postoperative chest drainage for the whole group was 7 days (mean 12 days) and median postoperative in-hospital stay was 13 days (mean 20 days). This is in stark contrast to the duration of hospitalization of patients prior to surgical referral (mean 103.6 days). There were five deaths. All occurred in patients with severe debilitating associated illnesses. In these patients initial drainage of the empyema space with a tube or by rib resection may have allowed recovery prior to more major surgery.