Two Decades of Thoracic Empyema in Ontario, Canada

Nayak, Rahul; Brogly, Susan B.; Lajkosz, Katherine; Lougheed, M. Diane; Petsikas, Dimitri

doi:10.1016/j.chest.2019.11.040

Cited by 16 publications

(14 citation statements)

References 8 publications

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“…Furthermore, our study supports the recent work of Nayak et al 2020, which analyzed the epidemiology and trends in management of thoracic empyema from 1996-2015 20 . Like our study, Nayak et al used the Charleston Comorbidity Index to analyze morbidity and mortality risk in their population.…”

Section: Discussionsupporting

confidence: 90%

“…They observed an increased incidence over time of thoracic empyema in patients aged 50-70 and postulated that this trend both re ects a change in the etiology of empyema from risk factors affecting a younger or more at risk population (IV drug use, Tuberculosis) as well as the greater presence of risk factors such as COPD and diabetes -both independent risk factors for empyema development -in the aging population 21 . Our study likewise had older patients (an average age of 59.44) with signi cant comorbidities as measured according to the CCI, supporting the changing epidemiological trends reported in Nayak et al 20 .…”

Section: Discussionsupporting

confidence: 90%

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Short and Long-Term Outcomes of Surgical Intervention for Empyema in The Post-Fibrinolytic Era

Cain

Margolis

Lazar

et al. 2021

Preprint

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Background: Open window thoracostomy is indicated for patients with bronchopleural fistulae or trapped lung in the setting of empyema refractory to non-surgical interventions. We investigated the role of open window thoracostomy in the era of minimally invasive surgeries, endobronchial valves and fibrinolytic therapy.Methods: A retrospective chart review of all patients who underwent open window thoracostomy at a single institution from 2010-2020 was performed. Indications for the procedure as well as operative details and morbidity and mortality were evaluated to determine patient outcomes for open window thoracostomy.Results: Eighteen patients were identified for the study. The most common indication for open window thoracostomy was post-resectional bronchopleural fistula (n=8). Patient comorbidities were quantified with the Charleston Comorbidity index (n=11 score≥5, 10-year survival ≤21%). Three (16.7%) patients died <30 days post-operatively and 12 (66%) patients were deceased by the study’s end (overall survival 24.0 ± 32.2 months). Mean number of ribs resected were 2.6 ± 1.2 (range 1-6). Patients were managed with negative pressure wound therapy (n=9) or Kerlix packing (n=9). Eleven patients (61.6%) underwent delayed closure (mean time from index surgery to closure 4.8 ± 6.7 months). Conclusions: Our study illustrates the significant comorbidities of patients undergoing open window thoracostomy, the poor outcomes therein, and pitfalls associated with this procedure. We show that negative pressure wound therapy can be utilized as potential way to obliterate the pleural space and manage an open chest in the absence of an airleak; however open window thoracostomy procedures continue to be extremely morbid.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

Short and Long-Term Outcomes of Surgical Intervention for Empyema in The Post-Fibrinolytic Era

Cain

Margolis

Lazar

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Furthermore, our study supports the recent work of Nayak et al 2020, which analyzed the epidemiology and trends in management of thoracic empyema from 1996 to 2015 [ 20 ]. Like our study, they used the CCI to analyze morbidity and mortality risk in their population.…”

Section: Discussionsupporting

confidence: 90%

“…They observed an increased incidence over time of thoracic empyema in patients aged 50–70 and postulated that this trend both reflects a change in the etiology of empyema from risk factors affecting a younger or more at risk population (intravenous drug use, tuberculosis) as well as the greater presence of risk factors such as COPD and diabetes – both independent risk factors for empyema development – in the aging population [ 21 ]. Our study likewise had older patients (an average age of 59.44) with significant comorbidities as measured according to the CCI, supporting the changing epidemiological trends reported in Nayak et al [ 20 ]…”

Section: Discussionsupporting

confidence: 90%

Short and long-term outcomes of surgical intervention for empyema in the post-fibrinolytic era

Cain

Margolis

Lazar

et al. 2021

J Cardiothorac Surg

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Background Open window thoracostomy (OWT) is indicated for patients with bronchopleural fistula (BPF) or trapped lung in the setting of empyema refractory to non-surgical interventions. We investigated the role of OWT in the era of minimally invasive surgeries, endobronchial valves and fibrinolytic therapy. Methods A retrospective chart review of all patients who underwent OWT at a single institution from 2010 to 2020 was performed. Indications for the procedure as well as operative details and morbidity and mortality were evaluated to determine patient outcomes for OWT. Results Eighteen patients were identified for the study. The most common indication for OWT was post-resectional BPF (n = 9). Prior to OWT, n = 11 patients failed other surgical or minimally invasive interventions. Patient comorbidities were quantified with the Charlson Comorbidity index (n = 11 score ≥ 5, 10-year survival ≤21%). Three (16.7%) patients died < 30 days post-operatively and 12 (66%) patients were deceased by the study’s end (overall survival 24.0 ± 32.2 months). Mean number of ribs resected were 2.5 ± 1.2 (range 1–6) with one patient having 6 ribs removed. Patients were managed with negative pressure wound therapy (n = 9) or Kerlix packing (n = 9). Eleven patients (61.6%) underwent delayed closure (mean time from index surgery to closure 4.8 ± 6.7 months). Conclusions Our study illustrates the significant comorbidities of patients undergoing OWT, the poor outcomes therein, and pitfalls associated with this procedure. We show that negative pressure wound therapy can be utilized as potential way to obliterate the pleural space and manage an open chest in the absence of an airleak; however, OWT procedures continue to be extremely morbid.

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“…The incidence of pleural infection nearly doubled from the first to the second decade of the 21st century. 11,12,14 In Europe, the US, Canada, and Australia, 5,6,8,13,14,16 the average age of patients diagnosed with pleural infection is 58-63 years. However, a recent systematic review pointed out a discrepancy in the age bracket of adult patients with pleural infection between high-income and low(er)-income countries, where patients in the latter group tended to be 15 years younger on average.…”

Section: Epidemiologymentioning

confidence: 99%

Recent Insights into the Management of Pleural Infection

Hassan

Patel

Sadaka

et al. 2021

IJGM

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Pleural infection in adults has considerable morbidity and continues to be a lifethreatening condition. The term "pleural infection" encompasses complicated parapneumonic effusions and primary pleural infections, and includes but is not limited to empyema, which refers to collection of pus in the pleural cavity. The incidence of pleural infection in adults has been continuously increasing over the past two decades, particularly in older adults, and most of such patients have comorbidities. Management of pleural infection requires prolonged duration of hospitalization (average 14 days). There are recognized differences in microbial etiology of pleural infection depending on whether the infection was acquired in the community or in a health-care setting. Anaerobic bacteria are acknowledged as a major cause of pleural infection, and thus anaerobic coverage in antibiotic regimens for pleural infection is mandatory. The key components of managing pleural infection are appropriate antimicrobial therapy and chest-tube drainage. In patients who fail medical therapy by manifesting persistent sepsis despite standard measures, surgical intervention to clear the infected space or intrapleural fibrinolytic therapy (in poor surgical candidates) are recommended. Recent studies have explored the role of early intrapleural fibrinolytics or first-line surgery, but due to considerable costs of such interventions and the lack of convincing evidence of improved outcomes with early use, early intervention cannot be recommended, and further evidence is awaited from ongoing studies. Other areas of research include the role of routine molecular testing of infected pleural fluid in improving the rate of identification of causative organisms. Other research topics include the benefit of such interventions as medical thoracoscopy, high-volume pleural irrigation with saline/antiseptic solution, and repeated thoracentesis (as opposed to chest-tube drainage) in reducing morbidity and improving outcomes of pleural infection. This review summarizes current knowledge and practice in managing pleural infection and future research directions.

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Two Decades of Thoracic Empyema in Ontario, Canada

Cited by 16 publications

References 8 publications

Short and Long-Term Outcomes of Surgical Intervention for Empyema in The Post-Fibrinolytic Era

Short and Long-Term Outcomes of Surgical Intervention for Empyema in The Post-Fibrinolytic Era

Short and long-term outcomes of surgical intervention for empyema in the post-fibrinolytic era

Recent Insights into the Management of Pleural Infection

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