Postgraduate medicine · 2026
Contemporary empyema treatment in the United States: predictors of surgical intervention following conservative management.
СтатьяНазвание и аннотация: Перевод в очереди
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Iqbal Ali, Saidy Saikou Omar, Baig Saqib
Аннотация
BACKGROUND: In the post-MIST-2 era, conservative-first management of empyema (antibiotics plus drainage with IET) is widely adopted, yet the real-world clinical course and predictors of surgical escalation remain unclear.
METHODS: Using HCUP-National Inpatient Sample (2016 through 2018), we identified adults hospitalized with a principal diagnosis of empyema (ICD-10-CM J86.9). We excluded interhospital transfers and cases with an initial invasive pleural procedure. Patients were grouped as (1) conservative only (needle drainage and/or tube thoracostomy and IET) or (2) surgical escalation after initial conservative care. Primary outcomes were escalation to invasive pleural procedures and hospital LOS; secondary outcomes included in-hospital mortality, discharge disposition, and costs. Multivariable logistic regression evaluated factors associated with escalation; negative binomial regression modeled LOS.
RESULTS: Among 2,336 admissions, 1,972 (84.4%) were managed conservatively and 364 (15.6%) escalated. IET was documented in 345/2,336 (14.8%) admissions. Patients were similar in age and sex. Escalated patients underwent more procedures (mean 6.4 vs 3.7). LOS was longer in the escalated group (14.4 vs 11.0 days), and mean costs were higher ($38,638 vs $26,212). In-hospital mortality remained low in both cohorts (2.3% in the conservative group vs 1.1% in the escalated group). In adjusted analyses, IET was associated with lower odds of invasive escalation (aOR 0.23; p < 0.001), while Black race (aOR 1.76; p = 0.003) and Hispanic ethnicity (aOR 1.56; p = 0.04) were associated with higher odds. Escalation was associated with longer LOS (IRR 1.33; p < 0.001), and IET was associated with a modest increase in LOS (IRR 1.12; p = 0.001).
CONCLUSIONS: Most adults with empyema managed initially with noninvasive pleural procedures did not require invasive escalation during index admission. Escalation was associated with greater procedural burden, longer LOS, and higher costs. IET was associated with lower odds of escalation but slightly longer LOS.
METHODS: Using HCUP-National Inpatient Sample (2016 through 2018), we identified adults hospitalized with a principal diagnosis of empyema (ICD-10-CM J86.9). We excluded interhospital transfers and cases with an initial invasive pleural procedure. Patients were grouped as (1) conservative only (needle drainage and/or tube thoracostomy and IET) or (2) surgical escalation after initial conservative care. Primary outcomes were escalation to invasive pleural procedures and hospital LOS; secondary outcomes included in-hospital mortality, discharge disposition, and costs. Multivariable logistic regression evaluated factors associated with escalation; negative binomial regression modeled LOS.
RESULTS: Among 2,336 admissions, 1,972 (84.4%) were managed conservatively and 364 (15.6%) escalated. IET was documented in 345/2,336 (14.8%) admissions. Patients were similar in age and sex. Escalated patients underwent more procedures (mean 6.4 vs 3.7). LOS was longer in the escalated group (14.4 vs 11.0 days), and mean costs were higher ($38,638 vs $26,212). In-hospital mortality remained low in both cohorts (2.3% in the conservative group vs 1.1% in the escalated group). In adjusted analyses, IET was associated with lower odds of invasive escalation (aOR 0.23; p < 0.001), while Black race (aOR 1.76; p = 0.003) and Hispanic ethnicity (aOR 1.56; p = 0.04) were associated with higher odds. Escalation was associated with longer LOS (IRR 1.33; p < 0.001), and IET was associated with a modest increase in LOS (IRR 1.12; p = 0.001).
CONCLUSIONS: Most adults with empyema managed initially with noninvasive pleural procedures did not require invasive escalation during index admission. Escalation was associated with greater procedural burden, longer LOS, and higher costs. IET was associated with lower odds of escalation but slightly longer LOS.