Original Article on Thoracic Surgery

Video-assisted thoracoscopic surgery in bacterial empyema thoracic result from developing country based on Thailand experience

Sira Laohathai, Sukasom Attanawanich, Montien Ngodngamtaweesuk, Piya Samankatiwat, Piya Cherntanomwong, Suraida Aeesoa, Kanok Suvarnakich, Sarina Sadade, Thasiwat Innipat, Padungkiat Tangpiroontham, Boonlawaat Homvises, Punnarek Thongjareon, Somchareon Saeteng, Sophon Siwachat, Emanuela Taioli, Apichat Tantraworasin


Background: Empyemathoracic is a common surgical disease which increasing every year in worldwideespecially in developing countries. Surgical technique is very challenging dueto technical demanding and time consuming. The aim of this study is to comparesurgical outcomes between open thoracotomy (OT) and video-assistedthoracoscopic surgery (VATS) in bacterial empyema thoracic based on Thailandexperience.
Methods: The retrospectivecohort study from 6 tertiary-care hospitals in Thailand was conducted. Patientswere diagnosed with bacterial empyema thoracis (BET) and underwent VATS or OTapproach between January 2015 to December 2017 were included in this study.Patient characteristics, operative procedures, perioperative complications andpostoperative outcomes were retrospectively reviewed from medical recordingsystem. Patients were divided into two groups; VATS and OT group. The endpointswere postoperative outcomes. The analysis was performed using multilevel modelstratified by propensity score (PS).
Results: There were 300 patients; 98 in VATS group and 202 inOT group, enrolled in this study. There were statistically significantdifferences in gender, comorbidity index, smoking status, stage of empyemathoracis, clinical presentation, duration of symptoms before diagnosis, andproportion of patients underwent decortication between two groups. Inpostoperative outcomes, the proportion of patients who had completedecortication and fully expanded lung was not different between VATS and OT(92.9% vs. 96%; P=0.236 and 89.9% vs. 88.1%; P=0.867). Afterusing multilevel model stratified by PS, VATS was associated with decreasedrisk of re-intubation [risk ratio (RR) =0.29, 95% CI, 0.09–0.98], woundinfection (RR =0.09, 95% CI, 0.01–0.71), duration of intensive care unit (ICU)stay [mean difference =−4.36; 95% CI, (−8.55 to −0.18)] and ventilatordependence (RR =0.61, 95% CI, 0.38–0.96) whereas hospital stay, compositepost-operative rate, mortality rate and discharge status were no differencebetween two groups.
Conclusions: VATS decortication is safe andeffective procedure for bacterial empyema thoracic and may reduce risk ofre-intubation, wound infection, duration of ICU stays and ventilatordependence. The prospective randomized controlled trial with larger sample sizeis warranted.

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