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Clinical Impact Of Urgent Thoracoscopic Drainage On Complicated Parapneumonic Infection With Short-term Antibiotic Usage
Younggi Jung, Eunjue Yi, Sungho Lee, Jae Ho Chug;
Korea University Anam Hospital, Seoul, Korea, Republic of
Objective: Prompt initiation of antibiotics and drainage of infection source is essential in the management of pleural cavity infection. Although surgical drainage is considered a gold standard of treatment for unresolved parapneumonic infection, optimal timing for surgical intervention is still under debate. Thus, we seek to analyze the clinical outcomes of thoracoscopic surgery for complicated parapneumonic effusion with regard to the duration of preoperative antibiotic usage.
Methods: Medical records were retrospectively reviewed for patients who received thoracoscopic surgery for complicated parapneumonic effusion or empyema. Patients were grouped according to the preoperative antibiotic durations and compared. Group A consists of the patients with less than 1 week of preoperative antibiotics usage and Group B consists of those with more than 1 week of antibiotic coverage. Basic demographics, preoperative chest computed tomography (CT) findings, antibiotics usage, duration until surgery and treatment outcomes were evaluated.
Results: From February 2008 to November 2018, a total of 180 patients underwent video-assisted thoracoscopic surgery (VATS) for pleural drainage or decortication of lung. Among 180 enrolled patients, the median duration of postoperative chest tube indwelling time showed no significant difference between the groups (5d vs. 6d, p=0.358), however the median duration of postoperative hospital stays (7d vs.9d, p=0.03), operation time (105min vs. 115min, p=0.034), and total duration of antibiotics use (10d vs. 19d, p=0.001) were significantly lower in the group A. There were two postoperative mortalities, one in each group, and four recurrences, all four in group A.
Conclusion: To achieve faster recovery with relatively safe and successful clinical outcomes, early thoracoscopic drainage could be considered on patients with complicated parapneumonic infection despite shorter antibiotics coverage.
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