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Video-assisted thoracoscopic surgery for thoracic empyema in patients on maintenance hemodialysis

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Abstract

Objective

Thoracic empyema in uremic patients on maintenance hemodialysis is a challenging situation. The clinical characteristics are rarely reported, and the surgical outcomes remain unclear. We report our experience with video-assisted thoracoscopic surgery in these patients during 10-year period of time.

Methods

Between 2005 and 2015, we retrospectively reviewed the clinical characteristics, bacteriological studies, and thoracoscopic surgical results of 23 empyema patients undergoing maintenance hemodialysis.

Results

The mean patient age was 67.1 ± 12.9 years. All patients had additional preexisting systemic diseases. The mean duration of hemodialysis was 34.7 ± 25.8 months. The infections causing empyema were pneumonia in 11 (47.8%), blood stream infection in 8 (34.8%), and uremic pleuritis in 4 (17.4%). Among the 22 identified microorganisms, the most common pathogen was methicillin-resistant Staphylococcus aureus (31.8%). After thoracoscopic surgery, 8 patients (34.8%) required additional procedures for complications, including 2 patients who required repeated thoracoscopy for hemothorax and 6 (26.1%) patients who required open drainage for residual empyema. The mean hospital stay was 62.4 days, and 6 patients (26.1%) died in the hospital. Univariate and multivariate analyses revealed that maintenance hemodialysis longer than 5 years was a significant factor associated with in-hospital mortality (odds ratio: 14.8, 95% confidence interval 1.5–151.6; p < 0.0001).

Conclusion

While surgical management of thoracic empyema in uremic patients undergoing maintenance hemodialysis is associated with high rates of complication and mortality, thoracoscopic surgery is feasible, especially for patients undergoing hemodialysis for less than 5 years.

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Funding

This study was supported by the National Taiwan University Hospital and National Taiwan University College of Medicine (NTUH 107C101-A3) of the Republic of China; Ministry of Science and Technology (MST 106-2314-B-002-241-MY2) and National Taiwan University Hospital and National Taiwan University College of Medicine (NTUH 107 FTN21).

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Author notes

  1. Hsien-Chi Liao and Jen-Hao Chuang contribute equally to this study.

Authors and Affiliations

  1. Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan South Road, Taipei, 100, Taiwan

    Hsien-Chi Liao, Jen-Hao Chuang, Hsao-Hsun Hsu, Ke-Cheng Chen & Jin-Shing Chen

  2. Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan

    Ke-Cheng Chen

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  1. Hsien-Chi Liao
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  2. Jen-Hao Chuang
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  3. Hsao-Hsun Hsu
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Correspondence to Ke-Cheng Chen.

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Disclosures

Doctors Hsien-Chi Liao, Jen-Hao Chuang, Hsao-Hsun Hsu, Ke-Cheng Chen, and Jin-Shing Chen have no conflicts of interest or financial ties to disclose.

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Liao, HC., Chuang, JH., Hsu, HH. et al. Video-assisted thoracoscopic surgery for thoracic empyema in patients on maintenance hemodialysis. Surg Endosc 34, 1641–1647 (2020). https://doi.org/10.1007/s00464-019-06935-3

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  • DOI: https://doi.org/10.1007/s00464-019-06935-3

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