Effectiveness of Video-Assisted Thoracoscopic Surgery Drainage and Debridement in the Treatment of Early Empyema Thoracis

Abstract

Background: Empyema thoracis is a serious pleural infection associated with significant morbidity and mortality. Early surgical intervention using video-assisted thoracoscopic surgery (VATS) may improve outcomes in selected patients; however, evidence from low-resource settings remains limited.

Methods: This retrospective observational study included 336 patients with empyema thoracis who underwent VATS drainage and debridement between January 2024 and December 2025 at a tertiary thoracic surgery center in Pakistan. Preoperative variables, operative findings, and postoperative outcomes were analyzed using SPSS version 26, and treatment success was defined as clinical and radiological resolution without need for further surgical intervention.

Results: Overall, 336 patients were analyzed with a mean age of 38.9 ± 12.6 years; 69.0% were male. Treatment success was achieved in 90.8% of patients, with a conversion to thoracotomy rate of 5.4% and 30-day mortality of 1.8%. Symptom duration >21 days, multiloculated disease, and diabetes mellitus were independent predictors of treatment failure and recurrence.

Conclusion: VATS drainage and debridement is an effective and safe approach for early empyema thoracis, providing high success rates with low morbidity and mortality in a resource-limited setting. Early intervention within four weeks of symptom onset is associated with improved outcomes, while delayed presentation, multiloculated disease, and diabetes adversely affect prognosis.