Comparison of outcome of surgery for tubercular and nontubercular empyema: An analysis of 285 consecutive cases

BACKGROUND: Few studies have compared the surgical outcomes between tubercular empyema (TE) and nontubercular empyema (NTE), which were limited by a small sample size. We conducted this study with the objective of comparing the surgical outcomes of patients with tuberculous and nontuberculous empyema. MATERIALS AND METHODS: This is a retrospective analysis of 285 consecutively operated cases of TE and NTE over 5 years conducted in a tertiary care center in New Delhi, India. A comparative analysis of demography, intraoperative, and postoperative variables including mortality between the two groups was carried out. RESULTS: Out of 285 patients, 166 were tubercular and 119 were nontubercular. Nontubercular group had significantly higher age (45.4 ± 17.2 vs. 31.2 ± 13.6 in years), more comorbidities. Procedure was started by thoracotomy in 25.9% of tubercular group and 41.1% of nontubercular group. In patients where procedure started by video-assisted thoracoscopic surgery (VATS), complete decortication could be achieved by VATS in 91.1% of TE patients, whereas it was possible in 77.2% of nontubercular group. Need for postoperative ventilation (10% vs. 1.2%, P = 0.0011) and intensive care unit (ICU) stay (25.2% vs. 3%, P = 0.001) was significantly higher in nontubercular group. Nontubercular group was found to have significantly higher number of complications (13.4% vs. 5.4%, P = 0.02) and postoperative mortality (10% vs. 0, P = 0.001). CONCLUSIONS: Higher percentage of TE cases were managed by VATS with reduced operative time, less blood loss, and lower conversions. Need for postoperative ventilation, ICU stay, and complications including mortality were more in NTE.