Complicated Pleural Infection is Associated With Prolonged Recovery and Reduced Functional Ability.

Publication Title

J Bronchology Interv Pulmonol

Authors

Austin M Meggyesy, Center for Lung Research in Honor of Wayne Gittinger, Swedish Medical Center and Cancer Institute, Seattle, Washington, USAFollow
Candice L. Wilshire, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WashFollow
Adam J Bograd, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA, USA.Follow
Shih-Ting Chiu, Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St Joseph Health, Portland, OregonFollow
Christopher R Gilbert, Swedish Cancer Institute Seattle, WashingtonFollow
Najib M Rahman
Eihab O Bedawi
Eric Vallieres, Division of Thoracic Surgery, Swedish Cancer InstituteFollow
Jed A Gorden, Swedish Cancer Institute Seattle, WashingtonFollow

Document Type

Article

Publication Date

10-1-2024

Keywords

washington; swedish; swedish thoracic; oregon; portland; Humans; Male; Female; Quality of Life; Middle Aged; Aged; Recovery of Function; Surveys and Questionnaires; Tissue Plasminogen Activator; Thrombolytic Therapy; Treatment Outcome; Return to Work; Fibrinolytic Agents; Adult; Pleural Diseases

Abstract

BACKGROUND: Management of complicated pleural infections (CPIs) had historically been surgical; however, following the publication of the second multicenter intrapleural sepsis trial (MIST-2), combination tissue plasminogen (tPA) and dornase (DNase) offers a less invasive and effective treatment. Our aim was to assess the quality of life (QOL) and functional ability of patients' recovery from a CPI managed with either intrapleural fibrinolytic therapy (IPFT) or surgery.

METHODS: We identified 565 patients managed for a CPI between January 1, 2013 and March 31, 2018. There were 460 patients eligible for contact, attempted through 2 phone calls and one mailer. Two questionnaires were administered: the Short Form 36-Item Health Survey (SF-36) and a functional ability questionnaire.

RESULTS: Contact was made in 35% (159/460) of patients, and 57% (90/159) completed the survey. Patients had lower QOL scores compared to average US citizens; those managed with surgery had higher scores in physical functioning (surgery: 80, IPFT: 70, P=0.040) but lower pain scores (surgery: 58, IPFT: 68, P=0.045). Of 52 patients who returned to work, 48% (25) reported an impact on their work effectiveness during recovery, similarly between management strategies (IPFT: 50%, 13/26 vs. surgery: 46%, 12/26; P=0.781).

CONCLUSION: Patients with a CPI had a lower QOL compared with average US citizens. Surgically managed patients reported improved physical functioning but worse pain compared with patients managed with IPFT. Patients returned to work within 4 weeks of discharge, and nearly half reported their ability to work effectively was impacted by their recovery. With further research into recovery timelines, patients may be appropriately counselled for expectations.

Specialty/Research Institute

Pulmonary Medicine

Specialty/Research Institute

Infectious Diseases

DOI

10.1097/LBR.0000000000000974