Abstract
Objective:
Empyema is a complication of
talc-
pleurodesis that may
lead to further surgical intervention and
death. Therefore, the present study's objective was to identify the
risk factors for the development of post-
pleurodesis empyema after
talc slurry
pleurodesis in order to better select
patients for this
procedure and minimize its
morbidity.
Methods:
Patients with
malignant pleural effusion who underwent
talc slurry
pleurodesis at the present institution from January 2018 to January 2020 were retrospectively analyzed. Post-
pleurodesis empyema was defined as pleural
infection up to 30 days after
pleurodesis. Using Cox
regression analysis, significant
prognostic factors for the development of
empyema were examined.
Results:
Of the 86
patients identified for inclusion in the study, 62 were
women (72%). Their mean age was 56.3±12.6 years. The median pleural
drainage time was 9 days, and 20
patients (23.3%) developed
empyema. In the univariate
analysis, both
drainage time (p = 0.038) and the use of
antibiotics prior to
pleurodesis (p < 0.001) were
risk factors for
pleural empyema.
Multivariate analysis also identified the use of
antibiotics as an independent
risk factor (
Odds Ratio [OR] 9.81; 95%
Confidence Interval [95% CI] 2.87-33.54). Although the pulmonary expansion was not associated with
empyema in the
multivariate analysis,
patients with less than 50% pulmonary expansion had a 4.5-times increased
risk of
empyema (95% CI 0.90-22.86; p = 0.067), and
patients with 50-70% pulmonary expansion had a 3.8-times increased
risk of
empyema (95% CI 0.98-15; p = 0.053) after
pleurodesis.
Conclusion:
The study suggests that
antibiotic therapy prior to
talc slurry
pleurodesis may increase the
risk of developing
empyema. Furthermore,
pleurodesis should be considered with caution in
patients with long-duration
chest tube placement and incomplete
lung expansion.