手术和非手术治疗胸腔积脓的结果：一项基于人群的研究。
Outcomes of Operative and Nonoperative Treatment of Thoracic Empyema: A Population-Based Study.
机构信息
Departments of Surgery and Medicine and Institute of Clinical Evaluative Sciences, Queen's University, Kingston, Ontario, Canada.
Departments of Surgery and Medicine and Institute of Clinical Evaluative Sciences, Queen's University, Kingston, Ontario, Canada.
出版信息
Ann Thorac Surg. 2019 Nov;108(5):1456-1463. doi: 10.1016/j.athoracsur.2019.05.090. Epub 2019 Jul 26.
BACKGROUND
The optimal management of thoracic empyema remains unclear. This study compared mortality and readmission risk after operative vs nonoperative treatment of thoracic empyema.
METHODS
Administrative universal health care data were used to conduct a retrospective population-based cohort study of thoracic empyema in Ontario, Canada. Individuals aged 18 years or older with a hospital discharge diagnosis of thoracic empyema from January 1, 1996, to December 31, 2015, were included. Treatment approach was classified as nonoperative (ie, chest tube with or without fibrinolytics) or operative (video-assisted thoracoscopic surgery [VATS] or open decortication). Modified Poisson regression was used to estimate adjusted risk ratios (RR) between treatment (open decortication was the reference group) and (1) death and (2) readmission. Analyses were also stratified by year of admission in 5-year intervals.
RESULTS
The study cohort comprised 9014 hospitalized individuals. Individuals treated nonoperatively had higher mortality risk as an inpatient (17.2% vs 10.6%; RR, 1.32-1.54), at 30 days (11.1% vs 4.2%; RR, 1.86-3.38), 6 months (26.6% vs 15.0%; RR, 1.38-1.59), and 1 year (32.3% vs 18.8%; RR, 1.38-1.59). No differences in 90-day readmission risk were observed. No effect measure modification was observed in models stratified by year of admission.
CONCLUSIONS
Nonoperative management of thoracic empyema was associated with higher risk of mortality compared with surgical decortication. Early thoracic surgical consultation is recommended.
背景
胸脓胸的最佳治疗方法仍不明确。本研究比较了手术与非手术治疗胸脓胸的死亡率和再入院风险。
方法
利用行政性全民医疗保健数据，对加拿大安大略省胸脓胸进行了回顾性基于人群的队列研究。纳入 1996 年 1 月 1 日至 2015 年 12 月 31 日期间有医院出院诊断为胸脓胸的年龄在 18 岁及以上的个体。治疗方法分为非手术（即，带或不带纤维蛋白溶解剂的胸腔引流管）或手术（电视辅助胸腔镜手术[VATS]或开放性胸廓剥脱术）。采用校正后的风险比（RR）估计治疗方法（开放性胸廓剥脱术为参考组）与（1）死亡和（2）再入院之间的风险比。还按入院年份分层进行了分析，每 5 年为一个时间段。
结果
研究队列包括 9014 名住院患者。非手术治疗患者的住院死亡率更高（17.2% vs 10.6%；RR，1.32-1.54），30 天死亡率（11.1% vs 4.2%；RR，1.86-3.38），6 个月死亡率（26.6% vs 15.0%；RR，1.38-1.59）和 1 年死亡率（32.3% vs 18.8%；RR，1.38-1.59）。90 天再入院风险无差异。在按入院年份分层的模型中未观察到效应测量修饰。
结论
与外科胸廓剥脱术相比，非手术治疗胸脓胸与死亡率升高相关。建议早期进行胸外科会诊。
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