ABSTRACT
Objective: To confirm that either Fibrinolytic therapy or open decortication which of the two is an effective First line treatment of pleural empyema
Methods: This prospective comparative study was conducted in the department of surgery Sheikh Zayed Medical College and Hospital, Rahim Yaar Khan. Seventy eight [78] patients were included in this study. There were two groups of patients; Group I [n=35] patients treated with fibrinolytic therapy, Group II [n=43] patients treated with open decortication. Data was entered and analyzed in SPSS v16. Student's t-test was used for comparison of quantitative variables. Chi-square and Fisher's Exact test were used for comparison of qualitative variables. P-value
Results: There was no significant difference in base baseline characteristics of patients of Group I and II. Incidence of comorbidities was also same between the groups. Most of the patients in Group I and II were in empyema stage III. Fluid cultures was positive in 33 [94.3%] patients in group I and 39 [90.7%] patients in group II. 30 [85.7%] was successfully treated using fibrinolytic therapy but this therapy failed in five [14.3%] patients, two of these patients expired within the hospital. There was only one [2.3%] treatment failure in open decortication Group that patient expired within the hospital [p-value 0.04]. Overall duration of hospitalization was significantly high in fibrinolytic group, this was 17.6 +/- 1.95 days versus 12.09 +/- 2.18 days in open decortication group [p-value <0.0001]. There was no significant difference regarding operative mortality within the two groups
Conclusion: Open Drainage is associated with better outcomes as compared to fibrinolytic therapy when used as a First line treatment of empyema