Reduction in the need for surgery and mortality after early administration of fibrinolytics following empyema drainage

Abstract OBJECTIVES Although intrapleural administration of fibrinolytics is an important treatment option for the management of empyema, the addition of fibrinolytics failed to reduce the need for surgery and mortality in previous randomized controlled trials. This study aimed to investigate the ef...

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Bibliographic Details
Published in:European journal of cardio-thoracic surgery 2024-07, Vol.66 (1)
Main Authors: Tamiya, Hiroyuki, Jo, Taisuke, Yokoyama, Akira, Sakamoto, Yukiyo, Mitani, Akihisa, Tanaka, Goh, Matsui, Hiroki, Ishimaru, Miho, Yasunaga, Hideo, Nagase, Takahide
Format: Article
Language:English
Subjects:
Adult
Aged
Chest Tubes
Drainage - methods
Empyema, Pleural - drug therapy
Empyema, Pleural - mortality
Empyema, Pleural - surgery
Female
Fibrinolytic Agents - administration & dosage
Fibrinolytic Agents - therapeutic use
Hospital Mortality
Humans
Japan - epidemiology
Length of Stay - statistics & numerical data
Male
Middle Aged
Propensity Score
Retrospective Studies
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Summary:Abstract OBJECTIVES Although intrapleural administration of fibrinolytics is an important treatment option for the management of empyema, the addition of fibrinolytics failed to reduce the need for surgery and mortality in previous randomized controlled trials. This study aimed to investigate the effects of administrating fibrinolytics in the early phase (within 3 days of chest tube insertion) of empyema compared with late administration or no administration. METHODS We used the Japanese Diagnosis Procedure Combination Inpatient Database to identify patients aged ≥16 years who were hospitalized and underwent chest tube drainage for empyema. A 1:2 propensity score matching and stabilized inverse probability of treatment weighting were conducted. RESULTS Among the 16 265 eligible patients, 3082 and 13 183 patients were categorized into the early and control group, respectively. The proportion of patients who underwent surgery was significantly lower in the early fibrinolytics group than in the control group; the odds ratio (95% confidence interval) was 0.69 (0.54–0.88) in the propensity score matching (P = 0.003) and 0.64 (0.50–0.80) in the stabilized inverse probability of treatment weighting analysis (P 
ISSN:1873-734X
1873-734X
DOI:10.1093/ejcts/ezae263