SURGICAL OUTCOMES OF SINGLE CHEST TUBE DRAINAGE IN OPEN DECORTICATION FOR TUBERCULOSIS EMPYEMA

Abstract

Background: Chronic tuberculous empyema continues to be one of the major thoracic surgical challenges in high tuberculosis-burden countries. Open decortication for re-expansion of the lung is usually indicated in stage III empyema. However, the most appropriate postoperative drainage technique remains widely debated. Double chest tubes have traditionally been utilized, but recent evidence indicates that single-tube drainage provides comparable efficacy with decreased morbidity and greater patient comfort.

Objective: To evaluate the clinical effectiveness and safety of single chest tube drainage following open decortication in patients with chronic tuberculous empyema.

Methods: A total of 270 patients diagnosed with stage III tuberculous empyema and undergoing open decortication were enrolled in the retrospective cross-sectional study that was conducted at Lady Reading Hospital from January 01,2023 to December 31, 2024. Sample size was estimated for an using the single-proportion formula, assuming a 95% confidence level (Z = 1.96) and a margin of error of 5%. Patients were managed with a single chest tube under direct vision following decortication. The variables, namely, duration of postoperative air leak, length of stay in the hospital, drainage volume, lung expansion, and complications, were analyzed using SPSS version 26.

Results: The mean age of patients was 38.4 ± 12.6 years, and 66.7% of the patients were male. The vast majority of patients had pulmonary tuberculosis (85.9%) and right-sided pathology (57.4%). Intraoperatively, dense pleural peel and multiloculated collections were noted in 88.5% and 74.8% of cases, respectively. The average operative time was 90 ± 25 minutes and average blood loss was 100 ± 20 mL. Postoperatively, average duration of drainage was 14 ± 2.3 days and average hospital stay was 3 ± 1.4 days. Overall, 19.6% of patients suffered complications, which included in the largest proportion prolonged air leak (8.9%) and surgical site infection (5.2%). At discharge, 85.6% of patients had total lung expansion and there were no deaths. The strongest predictors of lung expansion were a disease duration >2 months, the presence of multiloculated empyema, dense pleural peel and diabetes mellitus (p < 0.05).

Conclusion: A single chest tube in open decortication for post TB empyema is effective with decreased length of hospital stay, early mobilisation, and fewer complications.