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With Empyema, Size of Underlying Pneumonia Predicts Size of Empyema and Hospital Length of Stay
*Piroska Kopar, *Marc Jordaan, *Bryan P Stanifer, *Zhongze Li, William Nugent, *Cherie P Erkmen
Dartmouth-Hitchcock Medical Center, Lebanon, NH
OBJECTIVES
To evaluate the relationship between pneumonia and the size and clinical outcomes of subsequent empyema
DESIGN
Retrospective review
SETTING
Tertiary care academic hospital
PATIENTS
All adult patients admitted between 2006 and 2011 with the diagnosis of empyema
INTERVENTIONS
We developed a radiologic scoring system to characterize pneumonias into 4 categories based on size at the time of the patient’s presentation and emyemas into 3 groups based on size. Empyemas were additionally labeled as either loculated or not loculated. Epidemiologic data, data on interventions and outcomes were collected and analyzed with univariate and multivariate statistical models.
MAIN OUTCOME MEASURES
1. Parapneumonic empyema size and presence of loculation
2. Morbidity (length of stay, readmission, reoperation)
3. Mortality
RESULTS
A total of 187 patients were admitted to our hospital with a pleural empyema during the five years. Multivariate analysis showed that larger pneumonias were predictive of larger empyemas (p <0.0001) and longer hospital stays. Age, gender, presence of diabetes or lung cancer, smoking history and positive pleural cultures were not predictive of empyema size. Though larger and loculated empyemas were more likely to receive an operation (p<0.0001 and p<0.001 respectively), mortality, length of stay and readmission rates were not related. Patients with non-loculated empyemas were more likely to be readmitted than patients with loculated empyemas, but reoperation and mortality rates were the same between these groups.
CONCLUSIONS
The size of an empyema may be predicted based on the size of pneumonia. In patients with empyema, longer hospital stays may be expected for patients with larger underlying pneumonias at presentation. However, readmission rates and mortality are independent of size of either pneumonia or empyema.
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