Background: Video-assisted thoracic surgery is currently the recommended treatment for patients with empyema thoracis. However, open-window thoracostomy (OWT) is not uncommon and is performed as a last resort in patients who are in poor general condition or with complicated empyema. Although several professional associations have recommended vacuum-assisted closure (VAC) as an adjunct to standard treatment, exact data regarding the clinical role of intrathoracic VAC are not available. The primary objective of this study was to determine the safety and efficacy of intrathoracic VAC in debilitated patients and to compare the results with those of previous OWT studies.
Methods: We investigated 127 patients with a poor performance status who initially received inpatient intrathoracic VAC for stage II/III empyema thoracis between January 2010 and December 2020.
Results: The median duration of VAC was 15 days, and the median length of stay was 18 days. Two patients had complications, and the in-hospital mortality rate was 11.8% (15 of 127). Among the 112 surviving patients, 25 (22.3%) were discharged with OWT and 87 (77.7%) were discharged with a closed chest. Empyema recurred in 5 patients. Ultimately, we recorded an absolute success rate of 64.6% (82 of 127).
Conclusions: Intrathoracic VAC appears to be safer and associated with less morbidity and mortality than OWT in debilitated patients with empyema. Our results revealed a reduced hospital length of stay and an improved success rate. The results of this work should contribute to improving treatment success in pleural empyema patients.
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