A 3- Year Review of Patients with Chronic Empyema Treated Surgically at Tikur Anbessa Specialized Referral Hospital, Addis Ababa, Ethiopia

Abstract

Background: Empyema thoracic is one of the main causes of morbidity and mortality in developing countries. This study was aimed at determining the causes, clinical presentation, outcomes of surgical intervention and variables associated with adverse outcomes in patients with chronic empyema treated surgically. Methods: This was a cross sectional hospital based longitudinal case series analysis done at Tikur Anbessa Specialized referral hospital, Addis Ababa, Ethiopia. All patients admitted and operated for chronic Empyema over a period of three year. (April 01, 2011 - March 30, 2014) were studied. Results: A total of 62 patients were operated for empyema thoracis. The Male to female ratio was 5.9:1 and mean age at presentation was 29.96+/-10.6 years. Patients presented after an average of 8.02 +/- 4.37 months from the onset of symptoms (range from 1-16 months). Shortness of breath 43(69.4%), cough 43(69.4%), chest pain 47(75.8%), fever 30(48.4%), weight loss 21(33.9%) poor appetite 9(14.5%) and haemoptysis 1(1.6%) were the leading causes of symptoms on admission. Thirty seven (59.7%) patients were previously treated for tuberculosis, 11 (17.7%) had pneumonia and 53(85.5%) of them gave history of trauma. The right {32(51.6%)} and left pleural space, {29(46.8%)} were affected with similar incidence. Only one patient was admitted with bilateral empyema. In the majority of patients, 46(74.2%), open thoracotomy with abscess drainage and decortications were done. In addition to this, either lobectomy or pnemonectomy was done for 4 (6.5%) and 7 (11.3%) patients respectively. Three patients were treated by rib resection and open drainage. The average post-operative hospital stay was 12 days (range 3 - 63days). Major complications encounter were lung laceration 15(24.2%), BPF 8(12.9), recurrent empyema 10(16.1%), and persistent air space 14(22.6%). Two (3.2%) patients died in their hospital stay. During follow up visits, 52(83.9%) patients had shown significant subjective improvement of symptoms. Conclusion: In general, our experience on the outcome of open thoracotomy and decortication done for chronic empyema was excellent with low mortality and very good Functional results as majority of patients either returned to normal activities or showed significant improvement of symptoms.

Key words: Chronic Empyema, Decortication, Bronchopleural fistula