Surgical approach and outcomes of empyema patients in Prof. Ngoerah Hospital, Denpasar: a single-center retrospective observational study

Background: The number of patients with empyema thoracis is increasing with time despite rigorous prevention methods such as vaccination and antibiotic use. Surgical interventions are often required for advanced cases, though outcomes may differ due to other factors and staging. This study retrospectively evaluates the surgical management and outcomes of patients with empyema. Methods: We performed a retrospective observational study at the Cardiothoracic and Vascular Surgery Division in Prof Ngoerah Hospital from January 2019 to December 2021. Patients were diagnosed with imaging and pleural fluid analysis and referred to the cardiothoracic and vascular surgery department. About 22 patients were included in this study and had their demographic data, comorbidities, surgical interventions, and outcomes analyzed. A range of interventions was performed, such as open thoracotomy, video-assisted thoracoscopic surgery (VATS), or a combination. Outcomes assessed included the need for repeat surgery, length of hospital stay (LOS), and ICU stay. All data were analyzed using IBM® SPSS 26.0 using univariate descriptive analysis. Results: Out of the 22 patients (mean age 42.55 years), there were more males than females (68.2%), and half of them came into the hospital with complex empyema (Light’s Category 7). Open thoracotomy was the most common intervention (54.5%), followed by VATS (31.8%). Most patients (81.8%) did not require repeat surgeries. LOS ranged from 2 to 48 days (mean: 17.18), and ICU stays averaged 5.24 days. Comorbidities such as pneumonia (31.8%), tuberculosis (18.2%), and diabetes mellitus (13.6%) were seen. Conclusion: This study highlights possible barriers to providing optimal care to patients with empyema and its comorbidities and includes late diagnosis for favorable surgical outcomes. This issue is particularly significant, as a substantial proportion of patients continue to present with advanced stages of empyema.