SOUTH WEST COHORT STUDY IN PLEURAL EMPYEMA (SWIPE)

Introduction The optimal management of pleural infection is uncertain. Randomised controlled trials have demonstrated the efficacy of intrapleural fibrinolytics, but uptake into local guidelines has been variable. Anecdotally, the access to surgery on-site affects referral rates and timing. We aimed to assess the epidemiology and variability of management of pleural infection in the South-West of England using a novel registrar research collaboration. Methods Through the PRISM trainee network, respiratory and thoracic surgery registrars identified cases of pleural infection across the South West (9 sites) over a 6-month period. Inclusion criteria was based on previous epidemiological studies of pleural infection. Results From January 1st to June 31st 2020, 104 admissions to the selected hospitals with pleural infection had demographic, biochemical and outcome data recorded. The median age was 62 (IQR 51–76) and was male predominant (n=65/104). 25% had a positive pleural fluid culture (n=26). The median RAPID score of the group was 3 (33 low, 44 moderate, 27 high risk groups. None in the low risk group died and length of stay (median 17 days for entire cohort) was significantly longer with higher RAPID score (p-0.03). RAPID score was not associated with the need for surgery or fibrinolytics. Intrapleural fibrinolytics were used in 33% (n=34) at a median of 3 days after chest drain insertion. Forty patients were managed with thoracic surgery, 38/40 with Video-assisted thoracoscopic surgery (VATS) approach. Patients admitted to a surgical centre were more likely to have a surgical referral made and surgery performed sooner (3 days versus 8 days). There was no difference in hospital length of stay between patients managed with surgery or intrapleural fibrinolytics (p-0.56). Twelve patients died during their hospital admission (12%). Conclusion Management of pleural infection varied across the region. Patients admitted to surgical centres were more likely to be referred for surgery and we observed less use of intrapleural fibrinolytics in these hospitals. Hospital length of stay and mortality did not differ significantly between surgical and non-surgical centres.