Impact of Initial Surgical Interventions on Empyema Outcomes: Insights from a Cohort Study in Yemen

Abstract

Prupose: This study aimed to evaluate the effectiveness of different initial interventions, including thoracostomy drain tubes, open thoracotomy with decortication, and VATS (Video-Assisted Thoracoscopic Surgery) thoracoscopy, in the management of empyema. Patient and Methods: This prospective cohort study was conducted at two teaching hospitals in Sana'a, Yemen, over a two-year period, from 2022 to 2024. The study included 40 patients diagnosed with empyema. Patients were categorized according to the type of initial intervention received. Demographic data, clinical presentation, imaging findings, intervention details, and outcomes were systematically collected and analyzed. Statistical analyses were performed to identify associations between demographic characteristics, empyema stage, intervention type, and treatment success. Results The study included 40 patients, with a higher proportion of males (67.5%) than females (32.5%). The mean age was 47.1 years (SD: 12.85). The overall success rate of the initial interventions was 55%, with significant variation based on empyema stage, comorbidities, and intervention type. Stage I empyema had the highest success rate (80%, followed by Stage II (50%) and Stage III (27.3%), with a statistically significant difference (p-value = 0.034). Smoking history was identified as a significant negative predictor of success (p-value = 0.001). Higher pleural fluid pH was associated with better outcomes (p-value = 0.015*). The most common complications were chest infections (20%) and bronchopleural fistulas (10%), with a mortality rate of 7.5%. Conclusions The empyema stage significantly affects the success rate, with early stages showing better outcomes. Early and appropriate intervention, particularly in later stages, is crucial for better outcomes. Effective management of postoperative complications is vital. This study highlights the need for early diagnosis and tailored interventions based on the empyema stage to improve patient outcomes. Future research should focus on larger multicenter studies to validate these findings and develop standardized treatment protocols.