Comparing Initial Surgery versus Fibrinolytics for Pleural Space Infections: A Retrospective Multicenter Cohort Study.

Publication Title

Ann Am Thorac Soc

Authors

Candice L. Wilshire, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, 1101 Madison Street, Suite 900, Seattle, WA, 98104, USA.Follow
Anee Sophia Jackson, Division of Thoracic Surgery, Swedish Cancer Institute, 1101 Madison Street, Suite 900, Seattle, WA 98104, USA.Follow
Austin M Meggyesy, Center for Lung Research in Honor of Wayne Gittinger, Swedish Medical Center and Cancer Institute, Seattle, Washington, USAFollow
Kerrie E Buehler, Swedish Cancer Institute, 226698, Division of Thoracic Surgery and Interventional Pulmonology, Seattle, Washington, United States.
Shu-Ching Chang, Medical Data Research Center, Providence Health & Services, Portland, OR, USAFollow
Leah C Horslen, Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, 1101 Madison St, Suite 900, Seattle, WA, 98104, USAFollow
Joshua R Rayburn, Swedish Cancer Institute, 226698, Seattle, Washington, United States.
Carson C Fuller, Swedish Cancer Institute, 226698, Thoracic Surgery and Interventional Pulmonology, Seattle, Washington, United States.
Alexander S Farivar, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow
Adam J Bograd, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA, USA.Follow
Brian Louie, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow
Eric Vallieres, Division of Thoracic Surgery, Swedish Cancer InstituteFollow
Ralph W Aye, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow
Christopher R Gilbert, Swedish Cancer Institute Seattle, WashingtonFollow
Jed A Gorden, Swedish Cancer Institute Seattle, WashingtonFollow

Document Type

Article

Publication Date

7-13-2022

Keywords

washington; swedish; swedish cancer; swedish thoracic

Abstract

RATIONALE: When drainage of complicated pleural space infections alone fails, there exists two strategies in surgery and dual agent-intrapleural fibrinolytic therapy; however, studies comparing these two management strategies are limited.

OBJECTIVE: To determine the outcomes of surgery versus fibrinolytic therapy as the primary management for complicated pleural space infections.

METHODS: A retrospective review of adults with a complicated pleural space infection managed with surgery or fibrinolytics between 1/2015-3/2018 within a multicenter, multistate hospital system was performed. Fibrinolytics was defined as any dose of dual-agent fibrinolytic therapy and standard fibrinolytics as 5-6 doses twice daily. Treatment failure was defined as persistent infection with a pleural collection requiring intervention. Crossover was defined by any fibrinolytics after surgery or surgery after fibrinolytics. Logistic regression with inverse probability of treatment weighting (IPTW) were employed to account for selection bias effect of management strategies in treatment failure and crossover.

RESULTS: We identified 566 patients. Surgery was the initial strategy in 55% (311/566). The surgery group had less additional treatments [surgery: 10% (32/311) versus fibrinolytics: 39% (100/255), p

CONCLUSION: While there is a lack of consensus as to the optimal management strategy for patients with a CPSI, in surgical candidates operative management may offer more benefits and could be considered early in the management course. However, our study is retrospective and non-randomized; thus, prospective trials are needed to explore this further.

Area of Special Interest

Cancer

Specialty/Research Institute

Oncology

Specialty/Research Institute

Pulmonary Medicine

Specialty/Research Institute

Surgery

DOI

10.1513/AnnalsATS.202108-964OC