Long‐term outcomes in surgically intervened empyema patients: a systematic review

Background Pleural empyema is significant cause of morbidity and mortality. Debate in the literature exists regarding the best initial and definitive therapy, with recent research demonstrating superior short‐term outcomes with initial surgical intervention. Despite this, the impact of surgical intervention on long‐term outcomes has been incompletely described. A systematic review was undertaken to assess the current evidence evaluating the long‐term impact of surgical intervention. Methods A systematic review was undertaken according to PRISMA guidelines utilizing three databases. Articles included all papers where patients received surgical intervention for empyema with outcomes evaluated beyond 90 days. Two reviewers extracted and reviewed the articles. Grey literature was included. Results Eleven studies and two s were extracted. One study and two s evaluated the quality of life outcomes, two studies evaluated dyspnoea outcomes, seven studies evaluated long‐term lung function and two studies evaluated mortality and re‐admissions. 60–65% of patients had no dyspnoea between 2 and 7 years follow‐up. In six of seven studies, normal lung function was achieved in patients with chronic fibrothorax with FEV1% and FVC% improvements between 14–30% and 13–50%, respectively. The results from such biased cohorts could not be extrapolated to conclude that surgical intervention results in better outcomes than ICC drainage. Risk of bias was severe for all 11 studies. Conclusion Surgical intervention potentially improves post‐operative lung function, long‐term dyspnoea, and mortality. The impact this has on quality of life remains unknown. Future prospective trials with homogenous comparative groups are required to better define the role of surgery and its impact on long‐term outcomes. Long‐term outcomes in patients with post‐operative empyema who receive surgical intervention are scarcely reported. This review is the first to summarize and appraise the current evidence to evaluate long‐term outcomes in this population.