Original article: general thoracicMinimally invasive surgery in the treatment of empyema: intraoperative decision making
Section snippets
Material and methods
All patients undergoing surgical treatment for empyema under 1 surgeon’s care for the last 5 years were analyzed. Patients were considered to have empyema if they had fever, leukocytosis, pleural fluid with a pH less than 7.2, and a pulmonary infiltrate, with no other source of fever identified before or after the surgery. Positive cultures of neither fluid nor blood were required to make the diagnosis.
All patients were brought to the operating room, underwent general anesthesia, and then
Results
Demographic results are summarized in Table 2. A total of 172 patients underwent surgical treatment for empyema, 106 by open thoracotomy, and 66 by thoracoscopic drainage. Of the patients, 73% were men, of whom two thirds required open drainage. The remaining 27% of the patients were women, almost half of whom were treated thoracoscopically. Patients ranged in age from 3 to 92 years; there was no significant difference between the two groups. Most of the empyemas resulted from either primary or
Comment
Although the principles of drainage for empyema have not changed in the past 30 years, the acceptance by pulmonologists of the importance of early surgical drainage of empyema and of parapneumonic effusions has changed [4]. Drainage of parapneumonic fluid is recommended when patients have pus in the pleural space, pleural fluid with a positive Gram stain or culture, or pH less than 7.2 (Table 4) 5, 6. Typical management of a patient with parapneumonic effusions or empyema might include multiple
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2014, Journal of Surgical EducationCitation Excerpt :The Royal College of Surgeons has also produced guidance on emergency surgical admissions, which highlighted the need for meaningful quality indicators, such as time from decision to operate to time of operation to allow better planning of services.8 There is an increasing amount of literature on intraoperative decision making that focuses on the technical aspects of the procedures9-11 or how experts arrive at decisions under time pressure.12 Studies on preoperative decision making tend to involve investigative pathways or algorithms of care12-14 but do not offer a practical solution to improve surgical trainees’ decision-making skills.