Optimal Timing for Video-Assisted Thoracic Surgery Decortication in Chronic Empyema: A survival analysis

Abstract Background Video-assisted thoracic surgery decortication for phase 3 thoracic empyema is widely accepted, but the optimal timing for such surgical intervention has not been established. We aim to investigate and assess the optimal decortication timing, in terms of overall survival, for chronic empyema. Methods 204 patients with pneumonia-caused phase 3 empyema were treated with video-assisted thoracic surgery decortication over 10 years at Changhua Christian Hospital. The 90-day post-operative survival status was analyzed, and we compared the survivor group versus the non-survivor group. A receiver operating characteristic curve was used to identify the optimal decortication timing. Results A comparison of characteristics between survivors and non-survivors showed statistical differences among age, presence of cardiovascular disease, presence of end-stage renal disease, duration to surgery, length of intensive care unit stay, and overall length of hospital stay. Receiver operating characteristic curve analysis determined the cut-off for video-assisted thoracic surgery decortication, based on optimal 90-day post-operative survival, to be 7.5 days after hospitalization; mortality increases threefold thereafter. Multivariate analysis revealed that age, end-stage renal disease, pleural effusion pH ≦ 7.2 and duration to surgery > 7.5 days negatively impacted 90-day post-operative survival. Conclusions Patients who underwent decortication surgery within 7.5 days of hospital admission had better overall survival.