F. Farjah, R. G. Symons, B. Krishnadasan, D. E. Wood*, D. R. Flum. University of Washington, Seattle, WA,
Background: The management of pleural space infections has changed over the last two decades. This study evaluated trends in operative management, and outcomes associated with operative therapy.
Methods: A statewide administrative database cohort investigation was performed for pleural space infections occurring between 1987 and 2004. Temporal trends were described in six year time intervals.
Results: 3,511 patients (age 57.8 ± 18.7 years, 66% male, co-morbidity index of 1.2 ± 1.9) were hospitalized with a pleural space infection. The incidence of pleural space infections rose 3.2% per year (95% CI 2.5%-3.8%, p<0.001). Operative therapy increased over time (25.8%, 38.8%, 44.3%, p<0.001). 30-day mortality (12.4%, 12.5%, 10.4%, p=0.04) and length of stay (12 days, 11 days, 10 days, p=0.001) decreased, costs increased ($13,965, $15,376, $20,570, p<0.001), and re-admission rates did not change (11.4%, 10.3%, 11.0%, p=0.74). 30-day mortality was less for operated patients (3.2% vs 16.7%, p<0.001); however, operated patients were younger (51.7 ± 17.1 years vs 61.6 ± 18.6 years, p<0.001) and had a lower co-morbidity index (0.74 ± 1.48 vs 1.42 ± 2.14, p<0.001). After adjusting for age, gender, co-morbidity index, hospital, and year, operative therapy was associated with a 74% reduction in the risk of death (OR 0.26, 95% CI 0.18-0.37, p<0.001).
Conclusion: Operative management of pleural space infections has increased over time, and is associated with less mortality compared to nonoperative management. Consideration of early, aggressive surgical therapy for pleural space infection may result in better outcomes.
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