[Mortality prediction ability of phycians in intensive care units of Turkey (MOPAP)]. / Türkiye'de yogun bakim ünitelerinde hekimin mortaliteyi öngörebilme gücü.

INTRODUCTION: Intensive care physicians are increasingly involved in decision making about the prognosis of intensive care unit ICU patients. With this study; we aimed to evaluate the power of clinician foresight at prediction of mortality in patient at triage to intensive care and patient follow-up. MATERIALS AND METHODS: This study was conducted in ICUs located in various geographical regions of Turkey between January 1, 2017-April 30, 2017.The clinical research was planned as observational, multicenter, cross-sectional. RESULT: A total of 1169 intubated patients were followed in 37 different ICU. At the beginning of the follow-up we asked the physician who will follow the patient in the ICU to give a score for the probability of survival of the patients. Scoring included a total of 6 scores from 0 to 5, with the "0" the worst probability "5" being the best. According to this distribution, only 1 (0.9%) of 113 patients who were given 0 points survived. Three (6.1%) of 49 with the best score of 5 died. Survival rates were significantly different in each score group (r: -0.488; p<0.001). After the combined mortality estimation scores based on the clinical observations of the physicians (0 and 1 point score was combined as non-survive, 4 and 5 score was combined as survived) 320 of the 545 patients were estimated to be dead and 225 were predicted survival. Sensitivity and spesifity of scoring system to predict mortality was 91.56% (95% CI: 87.96-94.37), 76.89% (95% CI: 70.82-82.23) respectively. CONCLUSIONS: In this study, we concluded that the physicians who follow the patients in the ICU can predict the poor prognosis at the time of admission and the high mortality rate. The physician's opinion on mortality estimation should be considered in intensive care mortality scoring in addition to other laboratory and clinical parameters.

Comparison of perioperative outcomes of videothoracoscopy and robotic surgical techniques in thymoma.

OBJECTIVE: In this study, the perioperative outcomes of video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS) were compared in patients with clinical stage I and stage II thymoma. METHODS: The outcomes of 24 patients (10 males and 14 females; mean age: 42.5 years; range: 18-65 years) with diagnoses of clinical stage I and stage II thymoma who underwent VATS in our clinic between April 2010 and March 2018 were compared with the outcomes of 21 patients (8 males and 13 females; mean age: 41.2 years; range: 19-63 years) with the same clinical stages of thymoma who underwent RATS between March 2013 and May 2018. The operative times, postoperative complications, lengths of hospital stay, and total amounts of chest tube drainage of the patients were evaluated. RESULTS: No postoperative mortality was observed in either group. In general, VATS was performed from the right side, and RATS was performed from the right hemithorax. The operative time was significantly longer in the VATS group than in the RATS group (106.5 min versus 75.7 min, respectively; p < 0.001). In the VATS group, the total amount of postoperative drainage from the chest tubes was greater than that in the RATS group (210 ml versus 325 ml, respectively), and the drainage time was longer in the VATS group than in the RATS group (3 days versus 5 days, respectively; p < 0.001). The length of hospital stay was longer for the patients in the VATS group than for those in the RATS group (5.3 days versus 4.1 days, respectively; p < 0.001). The levels of pain were similar in both groups. No difference in the complication rates was found between the 2 groups. CONCLUSION: In the treatment of clinical stage I and stage II thymoma patients, the robotic approach and excision with VATS are techniques with equal reliability. However, the use of robot-assisted thoracoscopic thymectomy technique is advantageous in terms of decreasing the total amount of postoperative drainage and shortening the length of hospital stay.

Does the use of postoperative low-molecular-weight heparin in patients with lung cancer increase tube drainage?

BACKGROUND: The objectives of this study are to assess the chest drainage volumes of patients undergoing anatomic resection of non-small cell lung carcinoma and to determine the safety and effectiveness of administering enoxaparin for thromboprophylaxis. METHODS: A total of 77 patients were included in the study. A study was conducted on the first group of 42 patients in which enoxaparin prophylaxis (enoxaparin, 40 mg) was subcutaneously injected once a day for a period of three days after the patients underwent anatomic pulmonary resection between March 2016 and March 2018. An enoxaparin-free group was identified and included 35 patients who received no enoxaparin prophylaxis after undergoing anatomic pulmonary resection between February 2013 and February 2016. We compared the changes in hemoglobin (Hb) levels, postoperative 3-day drainage volume, transfusion volume, pulmonary complications and length of stay between the two groups. RESULTS: No differences in postoperative Hb levels, chest drainage volume, transfusion volume, postoperative complications, and length of stay were observed between the two groups. Deep-vein thrombosis was noted in a patient in the enoxaparin-free group. No major bleeding was noted in either group. CONCLUSION: We found that for patients undergoing anatomic resection of primary lung cancer, the blood transfusion and chest drainage volumes did not differ, regardless of whether the patients were given enoxaparin. To the best of our knowledge, the impact of low-molecular-weight heparin on chest tube drainage volume for patients undergoing anatomic resection of non-small cell lung carcinoma has not been investigated before.

Effects of Coronary Artery Bypass Grafting Surgery on Olfactory and Taste Functions.

BACKGROUND: Olfactory and taste sensations have a high impact on the quality of life. Impaired olfactory and taste functions may have a negative effect on physical and mental well-being, personal hygiene, and nutritional satisfaction, leading to the occurrence of depressive symptoms and impaired quality of life. Therefore, the recovery period of patients with disturbed olfactory and taste functions may be prolonged, and return to active life may be delayed. We designed this study to determine whether on-pump and off-pump coronary artery bypass grafting (CABG) surgeries have any effects on olfactory and taste functions and compare these functions between the surgical groups. METHODS: A total of 60 patients, who underwent elective isolated first-time CABG, were included in this study. Patients were divided into two groups as Off-Pump and On-Pump CABG groups with 30 patients in each group. In addition to patients' primary clinical and laboratory data, olfactory and taste functions were evaluated pre- and postoperatively in both groups separately, and then these functions were compared between the groups. Olfactory functions were evaluated by the Brief Smell Identification Test, while taste functions by the Burghart Taste test. RESULTS: Olfactory functions significantly were disrupted in the postoperative period in patients undergoing on-pump CABG (P value < .05), while these functions significantly were not affected in patients undergoing off-pump CABG (P value > .05). During the preoperative period, advanced age and smoking were detected to be independent predictors of impaired olfactory function for the study population. During the postoperative period, smoking, amount of postoperative bleeding and serum low-density lipoprotein (LDL) level were found to be independent predictors of impaired olfactory function for just the On-Pump CABG Group. In both groups, no significant deterioration in taste functions occurred during the postoperative period (P value > .05). CONCLUSION: Our study demonstrated that olfactory function was impaired in patients, who underwent on-pump CABG in the postoperative period, and significant impairment in taste function was present in neither off-pump nor on-pump CABG patients. However, the results of our study should be supported by more comprehensive, prospective, randomized controlled trials with more extensive patient series and by further tests.

Comparison of oxidant/antioxidant balance in COPD and non-COPD smokers.

BACKGROUND/AIM: Oxidative stress plays an important role in the pathogenesis of chronic obstructive pulmonary disease (COPD). Smoking is the leading source of oxidants in lungs. However, it is currently unknown why some individuals are more resistant to the detrimental effects of smoking and do not develop COPD. The aim in this study is to measure and compare the oxidant/antioxidant balance between in non-COPD individuals who smoke and COPD patients who smoke. MATERIALS AND METHODS: Included in the study were 137 patients with COPD and 102 healthy individuals. Participants were divided into groups as COPD patients (former and current smokers), non-COPD individuals who smoke and non-smokers healthy persons. In the following stage, the total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) levels were measured in serum for all participants. RESULTS: In the current-smoker COPD group, the level of oxidant status were significantly higher than the former-smoker COPD group (p < 0.001). Similarly, oxidant levels were significantly high in current-smoker healthy group than never smoker healthy group. According to these results TOS was associated with especially smoking status rather than COPD. Antioxidant status were similar between former-smoker COPD group and current-smoker COPD group. The antioxidant levels were found significantly low in current-smoker COPD patients, compared to the current-smoker non-COPD individuals (p = 0.007). Nevertheless, no significant difference was found in OSI levels between two groups. Briefly, high TOS and OSI values were correlated with only smoking, independently from COPD. CONCLUSION: It was concluded that there are complex pathogenetic mechanisms, including genetic and individual variations other than oxidant/antioxidant balance, involved in the development of smoking-related COPD. TOS and OSI values are not predictive parameters for the development of COPD, but high level of TAS in non-COPD smokers is promising for future studies.

Clinical analysis of pneumonectomy for destroyed lung: a retrospective study of 32 patients.

OBJECTIVE: Destroyed lung is whole lung destruction secondary to chronic or recurrent lung infections. This clinical condition can result in irreversible changes in the lung parenchyma. In this study, we aimed to evaluate patients undergoing pneumonectomy with a diagnosis of lung destruction in terms of surgical technique, post-operative morbidity and mortality, and long-term outcomes. METHODS: A total of 32 patients that underwent pneumonectomy due to a destroyed lung between 2005 and 2017 were retrospectively reviewed. Age, gender, presenting symptoms, etiologies, localization of the destruction, pre-operative medical history, pre- and post-operative respiratory function tests, intraoperative complications and bleeding volume, morbidity and mortality, length of hospital stay, and long-term follow-up outcomes were reviewed for each patient. RESULTS: The study included 32 patients with a mean age of 31.7 ± 10.8 years. All the patients presented with persistent cough, whereas sputum production was presented by 25, hemoptysis by 18, and chest pain by 11 patients. The underlying primary diseases included nonspecific bronchiectasis in 20 (62.5%), tuberculosis in 9 (28.1%), left pulmonary hypoplasia accompanied by Bochdalek hernia in 2 (6.2%), and aspiration of a foreign body lodged in the left main bronchus in 1 (3.1%) patient. Mean operative time was 220.6 ± 40.2 min and mean perioperative bleeding was 450.9 ± 225.7 ml. Post-operative complications occurred in 14.2% of the patients, most commonly including atelectasis associated with stasis of secretions and wound site infection. Mean post-operative hospital stay was 11.8 ± 2.8 days and mean follow-up period was 35.5 ± 28.3 months. A significant clinical improvement was observed in 81.2% of the patients post-operatively. CONCLUSIONS: Favorable long-term outcomes were obtained in our patients through careful patient selection and appropriate pre-operative work-up and surgical technique.

Serum prolidase activity, total oxidant/antioxidant, and nitric oxide levels in patients with esophageal squamous cell carcinoma.

BACKGROUND: This study aims to assess the prolidase activity, nitric oxide levels, and oxidative status in patients with esophageal squamous cell carcinoma. METHODS: The study included 30 patients with esophageal squamous cell carcinoma (11 males, 19 females; mean age 61±3 years; range, 28 to 77 years) and 30 healthy controls (10 males, 20 females; mean age 58±5 years; range, 31 to 73 years). Serum prolidase activity, total antioxidant capacity, total oxidant status, and nitric oxide levels were measured. In addition, the oxidative stress index was calculated. RESULTS: Prominently elevated serum prolidase activity, oxidative stress index values, total oxidant status, and nitric oxide levels were detected in the patient group (p<0.05). Lower total antioxidant capacity levels were observed in the patient group (p<0.05). CONCLUSION: Increased oxidant status with increased nitric oxide levels and prolidase activity were found in esophageal squamous cell carcinoma patients. Impairment of antioxidant mechanism with increased prolidase activity and nitric oxide levels may have a crucial role in the etiopathogenesis of esophageal squamous cell carcinoma.

Serum paraoxonase-1 enzyme activities and oxidative stress levels in patients with esophageal squamous cell carcinoma.

OBJECTIVES: Oxidative stress is well recognized to play a role in the pathogenesis of many diseases, including cancers. Paraoxonase-1 (PON1) is implicated in the elimination of carcinogenic lipid-soluble radicals produced by lipid peroxidation. Reports on PON1 activities in patients with cancer are conflicting. The aim of this study was to investigate serum antioxidant enzyme activities and oxidative stress levels in patients with esophageal squamous cell carcinoma (ESCC). PATIENTS AND METHODS: Thirty-two patients with ESCC and 33 healthy controls were enrolled. Serum malondialdehyde (MDA) levels and superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), glutathione reductase (GR), paraoxonase, and arylesterase activities were measured spectrophotometrically. RESULTS: Serum paraoxonase, arylesterase, SOD, activities, GSH-Px, and GR activities were significantly lower in patients with ESCC than in controls (all, P < 0.05), whereas serum MDA levels were significantly higher (P < 0.05). Serum MDA levels were significantly correlated with paraoxonase (r = -0.572, P < 0.001) and arylesterase activities (r = -0.597, P < 0.001) in patients with ESCC. CONCLUSIONS: This study indicated that ESCC is associated with increased oxidative stress and decreased antioxidant enzyme activities. Decreased serum PON1 enzyme activities may play a role in the progression and/or development of ESCC. Further studies are required to clarify these results.

Our eight-year surgical experience in patients with pulmonary cyst hydatid.

BACKGROUND: In this clinical retrospective study, we aimed to investigate our experinces and whether capitonnage is an effective therapy method for a pulmonary hydatid cyst or not. MATERIAL AND METHODS: A total of 412 patients with hydatid cyst operated in our hospitals were evaluated retrospectively between January 2003 and January 2011. In order to create a study group to compare the hydatid cyst operations with and without capitonnage in our department, 60 uncomplicated patients with the diagnosis of hydatid cyst who had undergone operations in the previous two years, were divided into two groups; while no capitonnage was performed and bronchial leaks were closed in one group, standard cystotomy plus the capitonnage operation was performed in the second group. All patients underwent surgery. RESULTS: In many patients, one or more symptoms were present on admission (339 cases, 82%). Perforated cysts/ nonperfore cysts rate was statistically significant (p = 0.001). There was no statistical difference between patients with or without capitonnage in terms of morbidity rates between patients with or without capitonnage (p = 0.041). However, morbidity rates were higher in the group without capitonnage. There were found statistically significant between capitonnage and non capitonnage groups in terms of length of hospital stay (p=0.001). CONCLUSIONS: In the surgical treatment, resection should be avoided as much as possible. An average time of 3-5 minutes should be allocated and capitonnage should be performed. Capitonnage should always be performed in the surgical treatment of hydatid cyst. We believe that povidone iodine per se provides sufficient disinfection.

The use of LigaSure Vessel Sealing System in Ivor Lewis esophagectomy.

BACKGROUND: This study investigated the results of the LigaSure Vessel Sealing System (LVSS), which has been routinely used in esophageal resections in our clinic since 2006. METHODS: For this purpose, 60 patients who underwent Ivor Lewis esophagectomy were included in the study. The results were compared with the patients who underwent stomach mobilising procedure and esophagectomy with conventional methods (conventional group) before 2006 and the patients who underwent LVSS (group of LigaSure) in surgical cases after 2006. The cases were compared particularly in terms of intraoperative bleeding, operative time, duration of postoperative hospital stay, intraoperative complications, mortality, and morbidity. RESULTS: Of the patients, 34 (% 56.6) were female and 26 (43.3%) were male, and the range of the age was between 33 and 78, and the mean age of the patients was 52.73 ± 11,617. While the amount of intraoperative bleeding was 321.864 ± 575.00 ml in the conventional group, this was found to be 370.31 ± 238.456 ml in the LigaSure group (p = 0.007). In the statistical evaluation of the operative time, the mean duration was determined as 310.00 ± 24.795 minutes in the conventional group, whereas it was determined as 265.16 ± 31.353 minutes in the LigaSure group (p = 0.001). CONCLUSIONS: The use of LVSS was associated with a significant reduction in the operative time and the rate of intra-operative complications.

Surgical treatment of pulmonary hydatid cysts, which perforated to the pleura.

OBJECTIVE: Hydatid cyst disease, endemic in Eastern region of Turkey, is a significant parasitic public health problem. In this study, pleural complications of hydatid cysts were presented in 76 cases. MATERIALS AND METHODS: In our study, of the 412 pulmonary hydatid cyst cases operated on between 2003 and 2011, 76 cases had ruptured into the pleura for various reasons, and the different clinicoradiological presentations were evaluated retrospectively. The age distribution of the cases was between 7 and 56 years, and the mean age was 26.20±13.04. RESULTS: The most frequent symptom due to pleural rupture in patients was dyspnea (44 cases, 57.8%). Etiologically, iatrogenic perforation was detected in four cases and thoracic trauma in nine cases (six car accidents and three falls from a height). An anthelmintic drug use history was found in three cases of ruptured pleura. Spontaneous perforation was detected in the other 60 (78.9%) cases. Two cases that were admitted to the emergency unit and were immediately administered a tube thoracostomy developed tension pneumothorax. In addition, 21 cases had hydropneumothorax, 17 had pneumothorax, and 36 had pleurisy. Morbidity was observed in 30 cases (39.4%). Atelectasis was the most frequent cause of morbidity in these patients (10 cases). The mean duration of hospitalization was determined to be 12.26±2.90 days. CONCLUSION: This disease can progress asymptomatically for a long time and can sometimes lead to life-threatening emergency situations, such as tension pneumothorax. The delayed admission of a patient to a physician causes the disease to become more complicated and to increase the morbidity and mortality rates. Treatment of the disease is in the form of surgery. Possible parenchymal protection should be applied in surgical treatment, and anatomic resection should not be performed unless necessary.

A long-term study assessing the factors influencing survival and morbidity in the surgical management of bronchiectasis.

BACKGROUND: Although the prevalence of bronchiectasis decreased significantly in developed countries, in less developed and in developing countries, it still represents a significant cause of morbidity and mortality. The aim of this retrospective study is to present our surgical experiences, the morbidity and mortality rates and outcome of surgical treatment for bronchiectasis. METHODS: We reviewed the medical records of 129 patients who underwent surgical resection for bronchiectasis between April 2002 and April 2010, at Van Training and Research Hospital, Thoracic Surgery Department. Variables of age, sex, symptoms, etiology, and surgical procedures, mortality, morbidity and the result of surgical therapy were analyzed retrospectively. RESULTS: Mean age was 21.8 year (the eldest was 67 year, the youngest was 4 years-old). Male/female ratio was 1.86 and 75% of all patients were young population under the age of 40. Bilateral involvement was 14.7%, left/right side ratio according to localization was 2.1/1. The most common reason for bronchiectasis was recurrent infection. Surgical indications were as follows: recurrent infection (54%), hemoptysis (35%), empyema (6%), and lung abscess (5%). There was no operative mortality. Complications occurred in 29 patients and the morbidity rate was 22.4%. Complete resection was achieved in 110 (85.2%) patients. Follow-up data were obtained for 123 (95%) of the patients. One patient died during follow-up. The mean follow-up of this patient was 9 months. Mean postoperative hospitalization time was 9.15 ± 6.25 days. Significantly better results were obtained in patients who had undergone a complete resection. CONCLUSIONS: Surgical treatment of bronchiectasis can be performed with acceptable morbidity and mortality at any age. The involved bronchiectatic sites should be resected completely for the optimum control of symptoms.

Impact of lymph node metastases in esophageal carcinoma patients is independent of patient age.

OBJECTIVE: The purpose of the present study was to define the clinicopathological features and prognosis of esophageal cancer. METHODS: Between 2004 and 2009, 128 patients with esophageal cancer were enrolled in a retrospective database and divided into two groups on the basis of number positive lymph nodes with the cut-off as four. RESULTS: The findings for 18 patients (14.0%) Group A were compared with those of 110 patients Group B. In the group A, there were significantly more women (12/6 vs. 54/56, P < 0.001). In both groups, the most frequent histological morphology was squamous cell carcinoma (83% and 75%, respectively), although the percentages were significantly different (P < 0.005). In the group A, lesions were more frequently located in the middle one-third of the esophagus than in the group B (61% vs. 28%, P < 0.001). Group A was more likely to be Stage IIa. Survival rates in group A patients at 5 years after resection were 15.8%, similar to those in group B patients (12.1%, difference not significant). Local lymph node metastases and microscopic residual tumor at the line of resection were also more prevalent in the young patients, but not to a statistically significant degree. CONCLUSIONS: These findings suggested that the clinical and pathologic features of carcinomas of the esophagus in young patients do not significantly differ from those in older patients.

Nonspecific infectious bilateral chylothorax and cyhloabdomen with symptoms of acute abdomen.

Co-existence of chylothorax and chyloabdomen is a rare clinical entity. Apart from surgery and extra-surgical trauma, malignancies, liver cirrhosis, nephrotic syndrome, thrombosis in the superior vena cava and acute pancreatitis play roles in the etiology. The case presented in this article was a 35-year-old woman, and the chronic infectious pathology in the cytology, plus the other supportive nonspecific infection parameters prompted us in establishing this diagnosis. Obstruction in the abdominal lymphatics leads to chylous ascites and chylothorax develops in due course. Similar to our case, the clinical entities of chylothorax and chyloabdomen of nonspecific infectious origin may co-exist in the same patient.

Altered serum levels of elements in acute leukemia cases in Turkey.

OBJECTIVE: The purpose of the study was to compare serum concentrations of some elements [zinc (Zn), copper (Cu), manganese (Mn), magnesium (Mg), lead (Pb), iron (Fe), cadmium (Cd) and cobalt (Co)] in acute leukemia patients with those of healthy subjects. METHODS: The study group consisted of newly diagnosed acute leukemia patients and the controls were matched for socioeconomic stauts and eating habits. The elements levels in the patient group were measured before treatment with an atomic absorption spectrophotometer. The selection criteria for the patients and controls were the lack of recent blood transfusion history and taking any medication with mineral supplement. RESULTS: The acute leukemia group composed of 42 patients and there were 40 persons in the control group. There was no difference between the age of the two groups (p=0.239). Serum levels of Zn, Mg and Mn were significantly lower with acute leukemia than in controls (p<0.001, p=0.011, p<0.001, respectively), while Cu, Pb and Cd were significantly elevated (p=0.003, p<0.001, p<0.001, respectively). There were no significant differences regarding Co and Fe (p=0.323 and p=0.508, respectively) CONCLUSION: In this study, we found levels of Zn, Mg and Mn to be lowered and of Cu, Pb and Cd to be elevated in patients with leukemia. Further studies are needed to clarify the role of these elements in pathogenesis of acute leukemia.

Erythrocyte catalase and carbonic anhydrase activities in lung cancer.

AIM: To study the relationship between the pathogenesis of lung cancer and antioxidant status and acidic media by measuring the activities of erythrocyte catalase (CAT) and carbonic anhydrase (CA). METHODS: A total of 26 patients with lung cancer and 15 healthy individuals were included in the study. The CAT and CA activities of erythrocytes were defined. The catalase (CAT) activity of erythrocytes was measured using Aebi's method. Carbonic anhydrase (CA) activity was analyzed by CO2 hydration. RESULTS: It was found that erythrocyte CA and CAT activities were significantly lower in patients with lung cancer compared to controls (p<0.05). Of the 26 patients with lung cancer, seven (26.9%) had metastasis, and the CA and CAT levels in patients with metastasis were significantly decreased (p=0.0001). CONCLUSIONS: Development of oxidative stress due to lung cancer may be related to the balance between prooxidant and antioxidant reactions. Catalase may have a preventive effect for malignant lung cancers and the gene of the antioxidant enzymes may be one of the anti-oncogenes, and inactivation of one of these genes in the process of carcinogenesis may lead to tumor development. This may be an explanation for the very low levels of antioxidant CAT in patients with lung cancer compared to healthy individuals. Carbonic anhydrase (CA) in tumor cells may be an indicator of the acid-base balance in lung cancer. Decreased levels of CA in patients with lung cancer may provide a convenient media for tumor development, growth and metastasis by creating an acidic media.

The risk factors and management of posttraumatic empyema in trauma patients.

BACKGROUND: Posttraumatic empyema increases patient morbidity, mortality and length of hospital stay, and the cost of treatment. The aim of this study was to identify the risk factors for posttraumatic empyema and to review our treatment outcomes in patients with this condition. METHODS: A total of 2261 patients who were admitted with thoracic traumas and underwent tube thoracostomy between January 1989 and January 2006 were investigated retrospectively. Posttraumatic empyema developed in 71 patients. Logistic regression was used to assess the association between potential risk factors for posttraumatic empyema. All values were expressed as the mean+/-S.D. RESULTS: Eight hundred and thirty-six (37%) of the patients had penetrating type trauma, while 1425 (63%) had blunt type trauma. The rate of posttraumatic empyema development was 3.1% for all patients. Pulmonary contusion was seen in 221 (9.8%) patients and fractures of more than two ribs were seen in 191 (8.4%) patients. Tube thoracostomy placement was performed in the emergency room in 1728 (76.4%) patients, in the hospital ward in 197 (8.7%), in the intensive care unit in 182 (8.0%), and in the operating room in 154 (6.8%). The duration of tube thoracostomy was 6.11+/-2.99 (1-21) days. Retained haemothorax was seen in 175 (7.7%) patients. The mean lengths of hospital and intensive care unit stay were 6.42+/-3.45 and 2.36+/-2.66 days, respectively. The analysis showed that duration of tube thoracostomy (OR, 2.49, p<0.001), length of intensive care unit stay (OR, 4.21, p<0.001), and presence of contusion (OR, 3.06, p<0.001), retained haemothorax (OR, 5.55, p<0.001), and exploratory laparotomy (OR, 2.46, p<0.001) were independent predictors of posttraumatic empyema. The relative risk of posttraumatic empyema was higher than 1 for each of the following risk factors: penetrating trauma (OR, 1.59, p=0.055), associated injuries (OR, 1.12, p=0.628) and fractures of more than two ribs (OR, 1.60, p=0.197). CONCLUSION: Prolonged duration of tube thoracostomy and length of intensive care unit stay, and the presence of contusion, laparotomy and retained haemothorax are independent predictors of posttraumatic empyema. Use of prophylactic antibiotics may be recommended in patients with these risk factors.