THE ROLE OF THE RAPID SCORE IN SURGICAL PLANNING FOR EMPYEMA

SESSION TITLE: Pleural Infections: Risk Factors and Management Options SESSION TYPE: Original Investigations PRESENTED ON: 10/22/2019 10:45 AM - 11:45 AM PURPOSE: The RAPID score (Renal, Age, Purulence, Infection Source and Dietary factors) is a validated scoring system which allows risk stratification in patients with pleural infection at presentation. Surgical intervention plays a key role in managing pleural empyema, specifically in stage 2 (fibropurulent) and stage 3 (organizing). Even when risk-adjusted, surgical management of pleural infections is associated with lower risk of early mortality. The purpose is to determine if the RAPID score is useful in identifying patients who would benefit from surgical intervention. We hypothesize that higher RAPID scores (≥4) would likely benefit from early surgery (<5 days from diagnosis). METHODS: A retrospective study on patients with complicated pleural effusions and/or empyema undergoing thorascopic or open surgical management of pleural infection admitted to multiple affiliated central Texas hospitals from September 1, 2014 – September 30, 2018. The primary outcome is 90-day mortality. The secondary outcomes are length of stay, 30-day readmission rate, and new organ failure. The outcomes will be compared between early surgery (<5 days from diagnosis) and late surgery (≥5 days from diagnosis), low (0-3) versus high (4-7) RAPID scores, low versus high RAPID scores in the early surgery group, and low versus high RAPID scores in the late surgery group. RESULTS: Of 264 patients in the study to date, complete data is currently available on 45 patients. 62% were male with a mean age of 57 years (SD ±16), 20% were readmitted, and 51% had organ failure. 90-day mortality was low at 2.22%. Intrapleural tissue Plasminogen Activator and DNase was given to 40% of the included patients. Patients with higher RAPID (HR) scores had a higher Charlson comorbidity index (CCI) (>5 vs <3), a higher mean length of stay (LOS)(27 vs. 15 days), and more readmissions (45% vs. 12%) compared to lower RAPID score (LR). Readmissions were similar with early surgery (ES) versus with late surgery (LS) at 20 % but organ failures were higher with ES versus LS (56% vs. 45%). Even though the LR/ES group had lower readmissions (11%), they had higher organ failures (61%) with a mean LOS of 13 days (SD ±5). The HR/LS group had high readmissions (50%) with organ failures (25%) and a mean LOS of 38 (SD ±38) days. CONCLUSIONS: Preliminary findings suggests a direct relationship between higher RAPID scores, CCI, length of stay, and readmission. Surgical timing with regard to RAPID scores appears complex and requires additional data and analysis in this ongoing study. CLINICAL IMPLICATIONS: The goal of the findings is to identify patients with pleural space infections that would benefit from early surgical intervention based off of the RAPID score. DISCLOSURES: No relevant relationships by Alejandro Arroliga, source=Web Response No relevant relationships by Matthew Crowe, source=Web Response No relevant relationships by Shekhar Ghamande, source=Web Response No relevant relationships by Ashley Liou, source=Web Response No relevant relationships by Sabine Povian, source=Web Response No relevant relationships by Heath White, source=Web Response No relevant relationships by Courtney Whitehurst, source=Web Response No relevant relationships by Kiumars Zolfaghari, source=Web Response