Clinical outcome of urgent thoracoscopic surgery on complicated parapneumonic infection with short-term preoperative antibiotic usage

Background: 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 urgent thoracoscopic surgery for complicated parapneumonic effusion regarding 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 3 days of preoperative antibiotics usage and Group B consists of those with more than 3 days of preoperative 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. Group A patients had higher C-reactive protein value (240 vs. 192 mg/L, P=0.003) and were given significantly shorter duration of total antibiotics (9 vs. 14 days, P<0.001). The median duration of postoperative chest tube indwelling time (5 vs. 5 days, P=0.38), postoperative hospital stays (8 vs. 8 days, P=0.56), operation time (105 vs. 105 min, P=0.88) showed no significant difference between the groups. CT images of Group A patients showed a significantly higher rate of multi-loculation (83 vs. 59, P=0.008) and interlobar effusions (64 vs. 42, P=0.02). There were two postoperative mortalities and four recurrences. Conclusions: Faster and relatively safe and successful clinical outcomes can be achieved with urgent thoracoscopic surgery on patients with complicated parapneumonic effusion despite limited duration of antibiotics coverage.