Pleural effusion: empyema: surgical drainage may lead to less time in hospital than non-surgical drainage

Clinical bottom line (level 1a-)

  1. Patients with a pleural empyema who received thoracoscopic drainage compared with thoracentesis spent had chest drains in for less time (on average 4 days fewer), and spent less time in ITU (on average 2 days fewer) and in hospital (on average 4 days fewer).
Coote : Cochrane Library 1999; 3 : -
Expires June 2004

The study

Systematic review of all randomised controlled trials of
  • Patients: pleural empyema
  • Intervention: surgical managment (thoracoscopy, thoracotomy) compared with non-surgical techniques (thoracocentesis, chest tube drainage)
  • Outcome: death, resolution of empyema, duration of chest tube drainage or hospital stay

Articles found in all languages using Cochrane Library, DARE database, Cochrane Acute Respiratory Infections Group, Embase, Medline, (search terms: detailed in text ) and hand-searching bibliographies of retrieved articles and review articles. Authors and experts in the field were contacted to identify missing articles.

Selection criteria: by 1 reviewers
Appraisal criteria: by 1 reviewer using Jadad criteria
Articles excluded if:
  • neonates enrolled
  • empyema due to malignancy or tuberculosis

1 RCT found involving 20 patients comparing chest tube drainage and streptokinase with video-assisted thoracoscopic surgery (VATS)

The evidence

Outcome Control Group
(SD)		 Experimental Group
(SD)		 Mean Difference
(95% CI)
days with chest tube in place 5.8
(1.1) 		9.8
(1.3) 		4.0
(2.9 to 5.1)
days in ITU 4.2
(1.8) 		1.8
(1.1) 		2.4
(1.0 to 3.8)
days in hospital 12.8
(1.1) 		8.7
(0.9) 		4.1
(3.2 to 5.0)

  • Treatment success VATS v. control: 91% v. 44% (p < 0.05, Fisher's Exact test)
  • The number of chest drains used per patients was similar between the two groups.

Comments

  1. The study was not blinded, patient selection was unclear and allocation concealment was uncertain.

Citation

  1. Coote N, : surgical versus non-surgical managment of pleural empyema. Cochrane Library 1999; 3 : -
Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, June 2002
Reviewer:

Clinical Question.
Patient pleural empyema
Intervention or Exposure rgical intervention - thoracenoscopy
Comparison non-surgical intervention - thoracentesis, chest drain
Outcome death, length of therapy