ABSTRACT BACKGROUND Video-assisted thoracic surgery is currently the recommended treatment
for patients with empyema thoracis. However, open window thoracostomy (OWT) is not
uncommon and is performed in patients who are in poor general condition or with complicated
empyema as a last resort. Although several professional associations have recommended
vacuum-assisted closure (VAC) as an adjunct to standard treatment, exact data regarding
the clinical role of intrathoracic VAC are not available. The primary objective of
this study was to determine the safety and efficacy of intrathoracic VAC in debilitated
patients and to compare the results with those of previous OWT studies. METHODS We
investigated 127 patients with a poor performance status who initially received inpatient
intrathoracic VAC for stage II/III empyema thoracis between January 2010 and December
2020. RESULTS The median duration of VAC was 15 days, and the median length of stay
was 18 days. Two patients had complications, and the in-hospital mortality rate was
11.8% (15/127). A total of 25/112 patients (22.3%) were discharged with OWT, 87/112
patients (77.7%) were discharged with a closed chest. Five patients experienced recurrence
of empyema. Ultimately, we recorded an absolute success rate of 64.6% (82/127). CONCLUSIONS
Intrathoracic VAC appears to be safer and associated with less morbidity and mortality
than OWT in debilitated patients with empyema. Our results revealed a reduced length
of hospital stay and an improved success rate. In conclusion, the results of this
work should contribute to improving treatment success in pleural empyema patients.
