Surgical Management of Complicated Pleural Effusion

Document Type : Original Article

Authors

1 Department of Cardiothoracic Surgery, Faculty of Medicine [for girls], Al-Azhar University, Cairo, Egypt

2 Department of Radiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

3 Department of Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Abstract

Background: Management of complicated pleural effusion [CPE] with loculation aims to relieve symptoms while allowing the treatment of the associated disease.
Aim of the work: This study aimed to analyze the effect of different management strategies on early outcomes.
Patients and Methods: This prospective study was conducted during the period from December 2021 to February 2022. 48 patients suffering from CPE were enrolled in this study. Patients were subjected to drainage of the effusion; and were categorized as follows: Group I: Tube drainage [TD]; Group II: Surgery after TD failure.
Results: Out of the included patients, 37 [77.09%] patients were treated with TD, and 11 [22.91%] patients were treated with surgery after the failure of TD. A positive culture was reported in 11 [29.7%], compared to 11 [100%] patients in the surgery group [P <0.001]. The surgery group had a significantly [P <0.001] higher WBC count and ESR, compared to those treated with TD [P = 0.006]. Hospital and ICU stays were significantly [P <0.001] longer in the surgical group compared to the TD group. We found a significant association between hospital stay and surgery after TD failure [B=4.81; P <0.001] and COPD [B= 1.86; P = 0.008], while a significant association was found between ICU stay and surgery after TD failure [B=3.68; P <0.001], COPD [B=1.05; p=0.016], and albumin [B=-1.04; P = 0.04].
Conclusion: TD is an effective approach to managing early-stage CPE cases, and it was associated with significantly lower hospital and ICU stays. However, in case of TD failure, immediate surgery should be performed. Despite the increased length of hospital and ICU stay in the surgery group, the application of surgery is lifesaving. 

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