Preoperative Predictors of Successful Surgical Treatment in the Management of Parapneumonic Empyema

Procalcitonin as preoperative marker for surgery in advanced parapneumonic empyema

“…The mean length of stay was postoperative 12.8 days and overall 18.7 days. These data are comparable with the current literature (2,3,5,14). Complications occurred in 21%, mortality was 5.25%, whereas the first is also well comparable with the values in literature, the second one is slightly lower.…”

“…Current literature quotes a mean postoperative length of stay between 8 and 20 days in cases of thoracotomy due to empyema. Postoperative morbidity ranges from 11% to 42% (2)(3)(4)(5)15). Therefore, parapneumonic empyema is a disease with a high burden for the patient and the most appropriate therapy has to be selected as early as possible to decrease delay between diagnosis and surgery.…”

“…There is current literature focusing on minimal-invasive thoracic surgery and on the identification of clinical predictors to operate successfully with thoracoscopic surgery to avoid thoracotomy and therefore major thoracic surgery (5,11,12). However, advanced parapneumonic empyema still often needs thoracotomy for complete pleural decortication (4,5,13,14).…”

“…Under the mentioned circumstances a surgical procedure is intended to free the trapped lung enabling a normal lung function rather than providing a rapid infection control. Based on these requirements strictly minimal invasive procedures are not sufficient enough and therefore at least partial open procedures such as decortication and/or pleurectomy are needed (4,5). Stable condition of patients and extent of surgical procedure do not necessitate an operative urgency comparable to early empyema and allow for that reason the best possible preparation to major surgery.…”

“…Chest roentgenograms 1 to 3 months postoperatively ( Figure 4) were compared with the preoperative roentgenograms ( Figure 1) and the radiological improvement was calculated using a 5-point percentage scale according to Casali et al (5,10). Complete re-expansion (100%) and moderate improvement (75%) were considered as satisfactory results.…”