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Ann Thorac Surg 1988;46:563-566
© 1988 The Society of Thoracic Surgeons

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Articles

The Surgical Management of Empyema Thoracis in Substance Abuse Patients: A 5-Year Experience

Divisions of Thoracic Surgery, Meharry Medical College, Nashville, TN; State University of New York Health Sciences Center at Brooklyn, Brooklyn, NY; and Brooklyn VAMC, Brooklyn, NY

Accepted for publication July 14, 1988.

^* Address reprint requests to Dr. Hoover, Department of Surgery, Meharry Medical College, 1005 D. B. Todd Blvd, Nashville, TN 37208

Postpneumonic empyema (EMP) may develop in substance abuse patients, requiring prolonged hospitalization. An algorithm that provides quality care and a rational basis for timely surgical intervention would be advantageous. We report our five-year experience with EMP in substance abuse patients and present such a treatment plan.

Sixty-one substance abuse patients were treated for EMP. Posteroanterior, lateral, and decubitus x-ray studies were obtained before treatment to assess fluid movement. Chest tubes were placed to drain frank pus and to obtain material for positive smears. X-ray studies and computed tomography were done 24 hours later to assess parenchymal pathology and to detect any multiple loculations. Thirty-three substance abuse patients recovered following initial tube thoracostomy and 7 after a second chest tube was introduced. Twenty-one had multiple loculations and underwent thoracotomy. Twenty of the 21 required extensive debridement or decortication, or both; 2 required lobectomy and 1 pneumonectomy. Chest tubes were removed on an average of 6 ± 1.5 days. Average postoperative stay was 10.7 ± 2 days. There were 2 early deaths and 1 late death and no recurrent EMP. Bacteriology findings were nonspecific and often polymicrobial. We conclude that early thoracotomy can be lifesaving in the presence of a benign clinical course.

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