Delayed referral reduces the success of video-assisted thoracoscopic debridement for post-pneumonic empyema
The aim of this study was to evaluate the effect of preoperative delay on the efficacy of video-assisted thoracoscopic surgery (VATS) for post-pneumonic pleural empyema (PPE). This was a prospective study of 39 consecutive patients with PPE who were treated by VATS with curative intent over a 4-year...
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| Veröffentlicht in: | Respiratory medicine 2001-10, Vol.95 (10), p.836-840 |
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| creator | WALLER, D.A. RENGARAJAN, A. NICHOLSON, F.H.G. RAJESH, P.B. |
| description | The aim of this study was to evaluate the effect of preoperative delay on the efficacy of video-assisted thoracoscopic surgery (VATS) for post-pneumonic pleural empyema (PPE). This was a prospective study of 39 consecutive patients with PPE who were treated by VATS with curative intent over a 4-year period. Failure to obtain full lung re-expansion resulted in conversion to thoracotomy. Pre- and post-operative variables were correlated with surgical outcome. VATS debridement was successful in 16 (41%) patients while conversion to open decortication was needed in 23 patients (21 immediate, two delayed). There was no difference in the age/sex distribution of the two groups. In the failed VATS group the delay from hospital admission to operation was longer: 24 (2·1) vs. 16·6 (2·7) days (P=0·03, 95% CI 0·53–14·3 days); operating time was longer: 128·2 (7·9) vs. 86·2 (10·4) min (P=0·003, 95% CI 15·2 – 68·5 min) and post-operative stay was longer: 8·4(0·8) vs. 5·2(0·6) days (P=0·03, 95% CI 1·1–5·3 days). VATS can be used successfully to treat PPE with a faster post-operative recovery when successful than open surgery. Delayed surgical intervention decreases the success of VATS thus earlier referral for surgical intervention in PPE (ideally within 21 days) is advocated to gain its full benefits. |
| doi_str_mv | 10.1053/rmed.2001.1176 |
| format | Article |
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This was a prospective study of 39 consecutive patients with PPE who were treated by VATS with curative intent over a 4-year period. Failure to obtain full lung re-expansion resulted in conversion to thoracotomy. Pre- and post-operative variables were correlated with surgical outcome. VATS debridement was successful in 16 (41%) patients while conversion to open decortication was needed in 23 patients (21 immediate, two delayed). There was no difference in the age/sex distribution of the two groups. In the failed VATS group the delay from hospital admission to operation was longer: 24 (2·1) vs. 16·6 (2·7) days (P=0·03, 95% CI 0·53–14·3 days); operating time was longer: 128·2 (7·9) vs. 86·2 (10·4) min (P=0·003, 95% CI 15·2 – 68·5 min) and post-operative stay was longer: 8·4(0·8) vs. 5·2(0·6) days (P=0·03, 95% CI 1·1–5·3 days). VATS can be used successfully to treat PPE with a faster post-operative recovery when successful than open surgery. Delayed surgical intervention decreases the success of VATS thus earlier referral for surgical intervention in PPE (ideally within 21 days) is advocated to gain its full benefits.</description><identifier>ISSN: 0954-6111</identifier><identifier>EISSN: 1532-3064</identifier><identifier>DOI: 10.1053/rmed.2001.1176</identifier><identifier>PMID: 11601751</identifier><language>eng</language><publisher>Oxford: Elsevier Ltd</publisher><subject>Adult ; Biological and medical sciences ; Chi-Square Distribution ; Debridement ; Empyema, Pleural - microbiology ; Empyema, Pleural - surgery ; Female ; Humans ; Klebsiella ; Klebsiella Infections - complications ; Klebsiella Infections - microbiology ; Klebsiella Infections - surgery ; Male ; Medical sciences ; pleural empyema ; Pneumococcal Infections - complications ; Pneumococcal Infections - microbiology ; Pneumococcal Infections - surgery ; pneumonia ; Pneumonia - complications ; Pneumonia - microbiology ; Prospective Studies ; Pseudomonas Infections - complications ; Pseudomonas Infections - microbiology ; Pseudomonas Infections - surgery ; Referral and Consultation ; Staphylococcal Infections - complications ; Staphylococcal Infections - microbiology ; Staphylococcal Infections - surgery ; Surgery (general aspects). 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This was a prospective study of 39 consecutive patients with PPE who were treated by VATS with curative intent over a 4-year period. Failure to obtain full lung re-expansion resulted in conversion to thoracotomy. Pre- and post-operative variables were correlated with surgical outcome. VATS debridement was successful in 16 (41%) patients while conversion to open decortication was needed in 23 patients (21 immediate, two delayed). There was no difference in the age/sex distribution of the two groups. In the failed VATS group the delay from hospital admission to operation was longer: 24 (2·1) vs. 16·6 (2·7) days (P=0·03, 95% CI 0·53–14·3 days); operating time was longer: 128·2 (7·9) vs. 86·2 (10·4) min (P=0·003, 95% CI 15·2 – 68·5 min) and post-operative stay was longer: 8·4(0·8) vs. 5·2(0·6) days (P=0·03, 95% CI 1·1–5·3 days). VATS can be used successfully to treat PPE with a faster post-operative recovery when successful than open surgery. Delayed surgical intervention decreases the success of VATS thus earlier referral for surgical intervention in PPE (ideally within 21 days) is advocated to gain its full benefits.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Chi-Square Distribution</subject><subject>Debridement</subject><subject>Empyema, Pleural - microbiology</subject><subject>Empyema, Pleural - surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Klebsiella</subject><subject>Klebsiella Infections - complications</subject><subject>Klebsiella Infections - microbiology</subject><subject>Klebsiella Infections - surgery</subject><subject>Male</subject><subject>Medical sciences</subject><subject>pleural empyema</subject><subject>Pneumococcal Infections - complications</subject><subject>Pneumococcal Infections - microbiology</subject><subject>Pneumococcal Infections - surgery</subject><subject>pneumonia</subject><subject>Pneumonia - complications</subject><subject>Pneumonia - microbiology</subject><subject>Prospective Studies</subject><subject>Pseudomonas Infections - complications</subject><subject>Pseudomonas Infections - microbiology</subject><subject>Pseudomonas Infections - surgery</subject><subject>Referral and Consultation</subject><subject>Staphylococcal Infections - complications</subject><subject>Staphylococcal Infections - microbiology</subject><subject>Staphylococcal Infections - surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the respiratory system</subject><subject>Thoracic Surgery, Video-Assisted</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>video-assisted thoracoscopy</subject><issn>0954-6111</issn><issn>1532-3064</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kTFv2zAQRomgRey4XTMGWtJNCk8iRWsMkjYJECBLOxM0eYKZSKLKkwz435eCjXbqxA_4Hg_HR8augRfAZXUXe3RFyTkUAKq-YGuQVZlXvBaf2Jo3UuQ1AKzYFdE757wRgl-yFUDNQUlYs49H7MwRXRaxxRhNl4KbLVI27TGj2aZIWWizg3cYckPkaUr4tA_R2EA2jN5mDncx9T0OU9aGmI2BpnwccO7DkGrsxyP25gv73JqO8Ov53LBfP77_fHjOX9-eXh7uX3MrVD3lSio0jZSi2bVbvsVSmi0Iu1OlqipXO1PyWoHEshRN1SrkmLIVTtXpccrwasO-neaOMfyekSbde7LYdWbAMJNWJTSNbCCBxQm0MRAlA3qMvjfxqIHrRa9e9OpFr170pgs358nzbmn-4mefCbg9A4as6dpoBuvpH5cWhPQHidueOEweDh6jJutxsOh8RDtpF_z_dvgDKMGXUw</recordid><startdate>20011001</startdate><enddate>20011001</enddate><creator>WALLER, D.A.</creator><creator>RENGARAJAN, A.</creator><creator>NICHOLSON, F.H.G.</creator><creator>RAJESH, P.B.</creator><general>Elsevier Ltd</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20011001</creationdate><title>Delayed referral reduces the success of video-assisted thoracoscopic debridement for post-pneumonic empyema</title><author>WALLER, D.A. ; RENGARAJAN, A. ; NICHOLSON, F.H.G. ; RAJESH, P.B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c476t-757ea95549bf808e25a814cb72733d6da206715e22493f7e0e5e2c4d764407a03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Chi-Square Distribution</topic><topic>Debridement</topic><topic>Empyema, Pleural - microbiology</topic><topic>Empyema, Pleural - surgery</topic><topic>Female</topic><topic>Humans</topic><topic>Klebsiella</topic><topic>Klebsiella Infections - complications</topic><topic>Klebsiella Infections - microbiology</topic><topic>Klebsiella Infections - surgery</topic><topic>Male</topic><topic>Medical sciences</topic><topic>pleural empyema</topic><topic>Pneumococcal Infections - complications</topic><topic>Pneumococcal Infections - microbiology</topic><topic>Pneumococcal Infections - surgery</topic><topic>pneumonia</topic><topic>Pneumonia - complications</topic><topic>Pneumonia - microbiology</topic><topic>Prospective Studies</topic><topic>Pseudomonas Infections - complications</topic><topic>Pseudomonas Infections - microbiology</topic><topic>Pseudomonas Infections - surgery</topic><topic>Referral and Consultation</topic><topic>Staphylococcal Infections - complications</topic><topic>Staphylococcal Infections - microbiology</topic><topic>Staphylococcal Infections - surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the respiratory system</topic><topic>Thoracic Surgery, Video-Assisted</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>video-assisted thoracoscopy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>WALLER, D.A.</creatorcontrib><creatorcontrib>RENGARAJAN, A.</creatorcontrib><creatorcontrib>NICHOLSON, F.H.G.</creatorcontrib><creatorcontrib>RAJESH, P.B.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Respiratory medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>WALLER, D.A.</au><au>RENGARAJAN, A.</au><au>NICHOLSON, F.H.G.</au><au>RAJESH, P.B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Delayed referral reduces the success of video-assisted thoracoscopic debridement for post-pneumonic empyema</atitle><jtitle>Respiratory medicine</jtitle><addtitle>Respir Med</addtitle><date>2001-10-01</date><risdate>2001</risdate><volume>95</volume><issue>10</issue><spage>836</spage><epage>840</epage><pages>836-840</pages><issn>0954-6111</issn><eissn>1532-3064</eissn><abstract>The aim of this study was to evaluate the effect of preoperative delay on the efficacy of video-assisted thoracoscopic surgery (VATS) for post-pneumonic pleural empyema (PPE). This was a prospective study of 39 consecutive patients with PPE who were treated by VATS with curative intent over a 4-year period. Failure to obtain full lung re-expansion resulted in conversion to thoracotomy. Pre- and post-operative variables were correlated with surgical outcome. VATS debridement was successful in 16 (41%) patients while conversion to open decortication was needed in 23 patients (21 immediate, two delayed). There was no difference in the age/sex distribution of the two groups. In the failed VATS group the delay from hospital admission to operation was longer: 24 (2·1) vs. 16·6 (2·7) days (P=0·03, 95% CI 0·53–14·3 days); operating time was longer: 128·2 (7·9) vs. 86·2 (10·4) min (P=0·003, 95% CI 15·2 – 68·5 min) and post-operative stay was longer: 8·4(0·8) vs. 5·2(0·6) days (P=0·03, 95% CI 1·1–5·3 days). VATS can be used successfully to treat PPE with a faster post-operative recovery when successful than open surgery. Delayed surgical intervention decreases the success of VATS thus earlier referral for surgical intervention in PPE (ideally within 21 days) is advocated to gain its full benefits.</abstract><cop>Oxford</cop><pub>Elsevier Ltd</pub><pmid>11601751</pmid><doi>10.1053/rmed.2001.1176</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Biological and medical sciences Chi-Square Distribution Debridement Empyema, Pleural - microbiology Empyema, Pleural - surgery Female Humans Klebsiella Klebsiella Infections - complications Klebsiella Infections - microbiology Klebsiella Infections - surgery Male Medical sciences pleural empyema Pneumococcal Infections - complications Pneumococcal Infections - microbiology Pneumococcal Infections - surgery pneumonia Pneumonia - complications Pneumonia - microbiology Prospective Studies Pseudomonas Infections - complications Pseudomonas Infections - microbiology Pseudomonas Infections - surgery Referral and Consultation Staphylococcal Infections - complications Staphylococcal Infections - microbiology Staphylococcal Infections - surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the respiratory system Thoracic Surgery, Video-Assisted Time Factors Treatment Outcome video-assisted thoracoscopy |
| title | Delayed referral reduces the success of video-assisted thoracoscopic debridement for post-pneumonic empyema |
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