Title : Epidemiological profile, diagnosis, and treatment of pleural empyema in adult population treated at a tertiary hospital in Brazil
Abstract:
Introduction: The complicated parapneumonic pleural effusion (CPPE), or empyema, stands for an important pneumonia’s complication, being associated to higher morbimortality, hospitalization and the frequent need to surgical approach. This article’s goal was to describe the epidemiology, diagnosis, treatment and outcome in CPPE in adults admitted in a public tertiary hospital in Brazil, during 2022 to 2024.
Methodology: A cross-sectional, retrospective study analyzing medical records of patients over 15 years old diagnosed with CPPE and followed by the thoracic surgery service from January 2022 to December 2024. Demographic data, diagnostic tests performed, treatment modalities used, average length of hospital stay, and mortality rates were collected. A descriptive analysis was performed.
Results: A total of 66 adults with CPPE (19 in 2022, 22 in 2023, and 25 in 2024) were identified during the study period. Regardless of the year analyzed, the majority of patients were male (75.8%). Regarding age group, in 2022 and 2023, the group over 45 years old predominated (63.2% and 77.3%, respectively). In 2024, the incidence was practically equivalent between the groups, with 13 patients under 45 years old and 12 over 45 years old. There was seasonality, with a higher number of cases in the winter months, averaging 15 diagnoses from May to August for each year analyzed. Chest X-ray was the primary diagnostic test used (40 patients, 16 in 2022, 12 in 2023, and 12 in 2024), followed by computed tomography (23 patients, 3 in 2022, 10 in 2023, and 10 in 2024), and pulmonary ultrasound, which was used in only 3 patients in 2024. All patients underwent some intervention in addition to antibiotic therapy, and in all years evaluated, the number of patients undergoing pleural drainage was higher than those undergoing any surgical procedure: 94.7% in 2022, 72.7% in 2023, and 68% in 2024. In 2022, the average length of hospital stay was 23 days and the mortality rate was 36.8% (7 cases); in 2023, the average length of hospital stay was 18 days and 5 patients died (mortality rate of 22.72%). In 2024, there were 3 deaths (mortality rate of 12%), and patients were hospitalized for an average of 15 days.
Conclusion: CPPE in adults is a serious condition with a high mortality rate. However, there has been a trend toward improved outcomes over the years, particularly in terms of mortality rates and length of hospital stay. This progress may be related to the adoption of more effective treatments, as evidenced by the increased use of pulmonary decortication and, above all, the growing use of less invasive approaches, such as video-assisted thoracoscopic surgery (VATS).
