Pediatric empyema thoracis: roles and outcomes of surgery in advanced disease

Abstract

Aim Empyema thoracis has become increasingly common in the pediatric population. Antibiotics and thoracostomy have been the cornerstones of management of stage 1 empyema, whereas management of stage 2 and 3 empyema remains controversial. Surgical intervention is perceived to be associated with high morbidity and protracted recovery. We aimed to review the role and outcome of surgical decortication, and provide data for comparison with other treatment modalities. Methods The medical records and clinical outcomes of 30 children (median age 5.2 years) with stage 2 or 3 empyema, who underwent surgical decortication from September 2017 to September 2019, were reviewed. Results Most children were referred for decortication by day 8.8 ± 4 of admission, and the median time from referral to surgery was 2.2 ± 2 days. All patients had tube thoracostomy, and 5 (17%) underwent fibrinolysis prior to surgery. Twenty-one (70%) patients required pediatric intensive care unit admission preoperatively. Postoperatively, most patients were extubated on day 2.5 (range 1–4 days), with chest tubes removed on day 3.8 (range 1–7 days). Most were discharge by day 6.2 (range 4–10 days). Postoperative air leak occurred in one (3%) patient. There was no mortality or reoperation. Conclusion Surgical decortication remains an excellent modality for managing stage 2 and 3 pediatric empyema. The procedure has a low morbidity and provides rapid resolution of symptoms with good clinical outcomes if performed promptly. Delayed referral may result in a more protracted clinical course.