Researchers from the University of Wisconsin, Madison, conducted a study to assess trends in hospitalizations for pneumonia complicated by empyema, and procedures for treating empyema, in children in the United States during the period 2008–2014. The investigators specifically evaluated trends in the use of video-assisted thoracoscopic surgery (VATS) or chest tube placement to treat empyema. Data were abstracted from the National Inpatient Sample, which includes information on discharges from a random sample of US hospitals and can be used to provide national estimates. Study participants were children aged 0–17 years with ICD-9 discharge diagnostic codes for pneumonia and empyema. Review of ICD-9 codes was also used to gather data on the use of specific procedures to treat empyema and the use of mechanical ventilation in study participants. Regression analyses were used to assess trends in rates of hospitalization for empyema, use of VATS or chest tube placement, length of stay (LOS), and mechanical ventilation during the study period. Data from 2012–2014 were included in logistic models to identify predictors of treatment failure, defined as the need for >1 pleural drainage procedure to treat empyema during a hospitalization. Year of hospitalization, mechanical ventilation, patient demographics, and hospital characteristics were included in this analysis.
During the study period, there were 14,255 discharges for empyema-related diagnoses in children. The rate of empyema hospitalizations decreased from 3 per 100,000 children to 2 per 100,000 between 2008 and 2014 (P=.04). The rate of mechanical ventilation in patients with empyema did not change significantly (13.2% of discharges in 2008 and 19.9% in 2014; P=.13). There was an increase in median LOS that did not reach statistical significance (9.3 days to 9.8 days; P=.053). During the study period, the proportion of empyema-related discharges associated with VATS as the only treatment procedure decreased significantly (from 41.4% to 36.2%; P=.03), and the proportion treated with only chest tube placement increased significantly (from 14.6% to 20.9%; P=.04). Overall, there was no significant change in the percentage of discharges associated with 1, 2, or 3 procedures to treat empyema. In the logistic model, the only variable significantly associated with treatment failure (need for >2 pleural drainage procedures) was mechanical ventilation.
The authors conclude that, during the period 2008–2014, there was a shift in treatment from VATS to chest tube placement for empyema in children and that this change was not associated with a significant increase in LOS or need for additional empyema-related procedures.
Dr Lesser has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Empyema, defined as pus in the pleural space, occurs most often as a severe complication of bacterial pneumonia. Although the prognosis for recovery is generally quite...