49 - Communication libre
Clinical works II
16 mai 2019, 10:15 - 11:45, Bellavista 2, 6ème étage


Clinical outcome of loculated parapneumonic effusions managed surgically or by intrapleural fibrinolysis: A comparative multicenter study
S. Federici1, B. Bedat2, E. Abdelnour1, S. Deckam2, J. Hayau1, M. Gonzalez1, T. Krueger1, L. Noirez1, F. Triponez2, W. Karenovic2, J. Y. Perentes1, Presenter: S. Federici1 (1Lausanne, 2Geneve)

The management of loculated parapneumonic effusions is debated and includes non-surgical (drainage+fibrinolysis) and surgical approaches (VATS/Thoracotomy). Here we present the outcome of patients with parapneumonic empyema managed over 4 years in two institutions, one with an early surgical and the other with a more conservative, non-surgical approach.
The charts of all patients with loculated parapneumonic effusions managed in both institutions between January 2014 and December 2017 were reviewed. All patients with persisting parapneumonic loculated pleural effusions on CT-scan despite chest tube drainage were managed preferentially by early surgery in one center (group I) and by fibrinolysis in the other (group II). For each patient, we recorded the age, gender, hospital stay, morbidity, mortality, infection control and pleural opacity decrease on chest X-ray before and 7 days after treatment.
Groups I (n=88) and II (n=78) did not differ regarding patient age (57±16 vs 60±17 years) and gender (70% vs 70% male). There was no 30-day mortality in both groups and no significant difference in morbidity with respect to hemothoraces (4.6% vs 8%) although significantly more arrhythmias were observed in group I compared to II (6% vs 0%, p<0.05)). In group I, 55 patients (62%) could be managed by VATS. In group II, 15 patients (20%) required an additional drainage while 12 patients (16%) had to undergo surgical decortication. The duration of chest tube drainage (4 [1-29] vs 6 [1-34] days, p<0.05) and hospital stay (12[3-157] vs 18 [4-373] days, p<0.05) were significantly lower in the group I but infection control (100%) and pleural opacity improvement were comparable in both groups (opacity decrease by -24±19% and -28±19 % in groups I and II respectively).
Surgically managed complicated parapneumonic effusions had a shorter hospitalization and chest tube drainage but overall clinical and radiological outcome was similar for surgical and non-surgical approaches.
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