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Surgical Endoscopy

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01-04-2020 | Thoracoscopy

Video-assisted thoracoscopic surgery for thoracic empyema in patients on maintenance hemodialysis

Authors: Hsien-Chi Liao, Jen-Hao Chuang, Hsao-Hsun Hsu, Ke-Cheng Chen, Jin-Shing Chen

Published in: Surgical Endoscopy | Issue 4/2020

Abstract

Objective

Thoracic empyema in uremic patients on maintenance hemodialysis is a challenging situation. The clinical characteristics are rarely reported, and the surgical outcomes remain unclear. We report our experience with video-assisted thoracoscopic surgery in these patients during 10-year period of time.

Methods

Between 2005 and 2015, we retrospectively reviewed the clinical characteristics, bacteriological studies, and thoracoscopic surgical results of 23 empyema patients undergoing maintenance hemodialysis.

Results

The mean patient age was 67.1 ± 12.9 years. All patients had additional preexisting systemic diseases. The mean duration of hemodialysis was 34.7 ± 25.8 months. The infections causing empyema were pneumonia in 11 (47.8%), blood stream infection in 8 (34.8%), and uremic pleuritis in 4 (17.4%). Among the 22 identified microorganisms, the most common pathogen was methicillin-resistant Staphylococcus aureus (31.8%). After thoracoscopic surgery, 8 patients (34.8%) required additional procedures for complications, including 2 patients who required repeated thoracoscopy for hemothorax and 6 (26.1%) patients who required open drainage for residual empyema. The mean hospital stay was 62.4 days, and 6 patients (26.1%) died in the hospital. Univariate and multivariate analyses revealed that maintenance hemodialysis longer than 5 years was a significant factor associated with in-hospital mortality (odds ratio: 14.8, 95% confidence interval 1.5–151.6; p < 0.0001).

Conclusion

While surgical management of thoracic empyema in uremic patients undergoing maintenance hemodialysis is associated with high rates of complication and mortality, thoracoscopic surgery is feasible, especially for patients undergoing hemodialysis for less than 5 years.

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Title: Video-assisted thoracoscopic surgery for thoracic empyema in patients on maintenance hemodialysis
Authors: Hsien-Chi Liao
Jen-Hao Chuang
Hsao-Hsun Hsu
Ke-Cheng Chen
Jin-Shing Chen
Publication date: 01-04-2020
Publisher: Springer US
Keywords: Thoracoscopy
Hemothorax
Published in: Surgical Endoscopy / Issue 4/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-06935-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Video-assisted thoracoscopic surgery for thoracic empyema in patients on maintenance hemodialysis

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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