CHEST Guidelines-Two-Decades-of-Thoracic-Empyema-in-Ontario,-Canada

Two-Decades-of-Thoracic-Empyema-in-Ontario,-Canada

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The study examined the epidemiology and management trends of thoracic empyema in Ontario, Canada, from 1996 to 2015. Using data from the Institute for Clinical Evaluative Sciences (ICES), researchers identified 9,306 cases of thoracic empyema. The incidence of empyema nearly doubled, rising from 2.9 to 6.7 cases per 100,000 population. The mean age of patients was 60.6 years, with an increasing proportion aged 50 to 70 years. Despite the rise, inpatient mortality rates decreased from 18.2% to 14.1%, with similar trends observed for 30-day, 6-month, and 1-year mortality.<br /><br />During the period, nonoperative management of empyema initially declined but rose post-2011, possibly due to the influence of new evidence supporting nonoperative therapies like dual intrapleural fibrinolytic therapy. The use of video-assisted thoracic surgery (VATS) increased, becoming a more common surgical intervention, though most patients were managed nonoperatively, reflecting a preference potentially driven by increasing patient comorbidities. The median hospital stay remained stable at 17 days.<br /><br />The incidence increase in older adults and those with comorbidities suggests a shift in etiology toward frailty-associated risk factors such as aspiration pneumonia, compared to traditional risk factors linked to younger demographics. The findings underscore an evolving approach to managing empyema, emphasizing nonoperative strategies amidst a demographic with higher comorbid risk factors. This reflects a trend toward less invasive management where operative measures are reserved for non-responders to conservative treatments. The study is one of the most extensive analyses focusing on thoracic empyema trends, highlighting changing patterns and preferences in treatment.

Keywords

thoracic empyema

epidemiology

Ontario

nonoperative management

video-assisted thoracic surgery

intrapleural fibrinolytic therapy

incidence trends

mortality rates

comorbidities

frailty-associated risk factors