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Comparing TPA/Dornase and VATS for Empyema Management: Impact of Patient Factors on Recurrence and Outcomes
Ahmed A. Elkamel, *Timothy Harris, *Kevin Wang, *Shamele Battan-Wraith, *Evelyn Alexander, *Titilope Sandra Saheed, *Mazin Abdalgadir, *Kameron Durante, Nikolas Brzezinski, Ramya Mohankumar, *Kyra Sing, *Jonathan Rice, *Stephanie Worrell, *Praveen Sridhar
Surgery, The University of Arizona, Tucson, Arizona, United States
Objective: Definitive empyema management requires appropriate antibiotics and drainage, and surgical debridement versus thoracostomy drainage is based on clinical status. This study aims to compare patient factors, clinical outcomes and recurrence rates between patients treated with intrapleural TPA/Dornase and Video-Assisted Thoracoscopic Surgery (VATS).
Methods: A retrospective cohort single-institution study was conducted, including 134 patients diagnosed with empyema between 2018 and 2024. Characteristics and clinical outcomes recorded included chest tube size, location and duration. Antibiotic and pain pharmaceutical regimens were measured. Logistic regression was used to assess predictors of empyema recurrence. Chi-square and MannWhitney U tests were employed for statistical analysis, with significance set at p<0.05.
Results: Between the 134 patients who met the inclusion criteria, 67% patients (n=89) received TPA/Dornase (n=89) and 33% VATS (n=45). Patient factors such as COPD (OR: 2.76, 95% CI: 1.35–5.62, p=0.011), pleural fluid culture positivity (OR: 2.24, 95% CI: 1.11–4.52, p=0.022), and prior thoracic surgeries (OR: 3.58, 95% CI: 1.09–11.70, p=0.036) were significant predictors of recurrence. However, neither treatment modality showed superiority in preventing recurrence. Antibiotic requirement was significantly reduced in patients undergoing VATS only (18.56 vs 42.83, p=0.009).
Conclusions: Both TPA/Dornase and VATS are effective in managing empyema. Patient factors, particularly COPD, culture positivity, and prior thoracic surgeries, significantly influence recurrence risk. Antibiotic regimen was significantly reduced in patients receiving VATS alone, reflecting potential conservative antibiotic stewardship with surgery alone. These findings suggest that clinical decision-making should be personalized, focusing on patient characteristics to optimize outcomes.
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