Profile and outcome of patients referred for thoracic empyema in Bloemfontein, South Africa

Objective. To establish the profile and outcome of patients referred to the Department of Cardiothoracic Surgery at Pelonomi Hospital, Bloemfontein for management of thoracic empyema. This was considered important in view of the proposed restructuring of health services in the Free State. Methods. Files of 77 consecutive patients referred to the Department of Cardiothoracic Surgery at Pelonomi Hospital were reviewed. The effect of the condition of the ipsilateral lung on the outcome was statistically analysed. This series was compared with a similar size series from Crawford Hospital in Atlanta, Georgia, USA. Results. The male-to-female ratio was 6:1. Eighty-three per cent of patients were referred from a hospital. The aetiology included a wide variety of causes, but trauma (56%), destroyed lung (10%) and pneumonia (9%) were the most common causes. Active tuberculosis was diagnosed in 6 patients, and the prevalence of HIV was 16%. Mismanagement had probably occurred in 21 cases (27%), usually involving an intercostal drain left in for too long. Surgery was eventually necessary in 52 cases (68%). The final outcome was good in 64 of the 77 patients (83%). Conclusions. The high prevalence of surgery requires timely referral to a specialised cardiothoracic surgeon, and facilities should be available. Empyema associated with a diseased lung, especially a destroyed lung, is a therapeutic challenge and the outcome is often unsatisfactory.