• Rahul Nayak, Susan B Brogly, Katherine Lajkosz, M Diane Lougheed, and Dimitri Petsikas.
• Departments of Surgery and Medicine and Institute of Clinical Evaluative Sciences, Queen's University, Kingston, Ontario, Canada. Electronic address: rnayak@qmed.ca.
• Ann. Thorac. Surg. 2019 Nov 1; 108 (5): 1456-1463.

BackgroundThe optimal management of thoracic empyema remains unclear. This study compared mortality and readmission risk after operative vs nonoperative treatment of thoracic empyema.MethodsAdministrative universal health care data were used to conduct a retrospective population-based cohort study of thoracic empyema in Ontario, Canada. Individuals aged 18 years or older with a hospital discharge diagnosis of thoracic empyema from January 1, 1996, to December 31, 2015, were included. Treatment approach was classified as nonoperative (ie, chest tube with or without fibrinolytics) or operative (video-assisted thoracoscopic surgery [VATS] or open decortication). Modified Poisson regression was used to estimate adjusted risk ratios (RRadj) between treatment (open decortication was the reference group) and (1) death and (2) readmission. Analyses were also stratified by year of admission in 5-year intervals.ResultsThe study cohort comprised 9014 hospitalized individuals. Individuals treated nonoperatively had higher mortality risk as an inpatient (17.2% vs 10.6%; RRadj, 1.32-1.54), at 30 days (11.1% vs 4.2%; RRadj, 1.86-3.38), 6 months (26.6% vs 15.0%; RRadj, 1.38-1.59), and 1 year (32.3% vs 18.8%; RRadj, 1.38-1.59). No differences in 90-day readmission risk were observed. No effect measure modification was observed in models stratified by year of admission.ConclusionsNonoperative management of thoracic empyema was associated with higher risk of mortality compared with surgical decortication. Early thoracic surgical consultation is recommended.Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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