Predicting factors for outcome of tube thoracostomy in complicated parapneumonic effusion or empyema

Study objectives: To determine the predicting factors for outcome of tube thoracostomy in patients with complicated parapneumonic effusion (CPE) or empyema. Design and settings: Retrospective chart review over a 55-month period at a tertiary referred medical center. Patients and measurements: The medical charts of patients with empyema or CPE were reviewed. Data including age, gender, clinical symptoms, important underlying diseases, leukocyte count, duration of preadmission symptoms, interval from first procedure to second procedure, the time from first procedure to discharge (recovery time), the amount of effusion drained, administration of intrapleural streptokinase, chest tube size and position, loculation of pleural effusion, and characteristics and culture results of pleural effusion were recorded and compared between groups of patients with successful and failed outcome of tube thoracostomy drainage. Results: One hundred twenty-one patients were selected for study. One hundred of these patients had received tube thoracostomy drainage with 53 successful outcomes and 47 failed outcomes of chest tube drainage. Nineteen patients received decortication directly, and the other two received antibiotics alone. Univariate analysis showed that pleural effusion leukocyte count, effusion amount, and loculation of pleural effusion were significantly related to the outcome of chest tube drainage. Multiple logistic regression analysis demonstrated that loculation and pleural effusion leukocyte count ≤6,400/μL were the only independent predicting factors related to failure of tube thoracostomy drainage. Conclusions: Loculation and pleural effusion leukocyte count ≤ 6,400/μL were independent predicting factors of poor outcome of tube thoracostomy drainage. These results suggest that if the initial attempt at chest tube drainage fails early surgical intervention should be considered in good surgical candidates with loculated empyema or pleural effusion with leukocyte count ≤ 6,400/μL.