Incidence of Empyema Thoracis in Patients Discharged with Chest Tube In Situ After Emergency Tube Thoracostomy

Sadaf Zafarullah; M. Hammad Shoaib Nabi; Muhammad Rehman Waheed

doi:10.54112/bcsrj.v6i4.2262

Authors

Sadaf Zafarullah Department of Thoracic Surgery, Mayo Hospital, Lahore, Pakistan
M. Hammad Shoaib Nabi Department of thoracic Surgery, Services Institute of Medical Sciences, Lahore, Pakistan
Muhammad Rehman Waheed Department of Paediatric Surgery, Mayo Hospital, Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i4.2262

Keywords:

Empyema, Pleural; Thoracostomy; Chest Tubes; Pneumothorax; Hemothorax; Thoracic Injuries

Abstract

Tube thoracostomy is frequently performed as an emergency thoracic procedure for pneumothorax, haemothorax, traumatic chest injury, massive pleural effusion and tension pneumothorax. Although discharge with a chest tube in situ may reduce hospital stay, it can increase the risk of post-discharge complications, particularly empyema thoracis, when follow-up and tube care are suboptimal. Objective: To determine the incidence of empyema thoracis among patients discharged with a chest tube in situ after emergency tube thoracostomy. Methods: This prospective cohort study was conducted in the Department of Thoracic Surgery, Mayo Hospital, King Edward Medical University, Lahore, Pakistan, from September 2024 to February 2025. A total of 69 adult patients who underwent emergency tube thoracostomy and were discharged with a chest tube in situ were included. Patients with previous thoracic surgery, previous empyema, immunocompromised status, diabetes mellitus, pregnancy, incomplete records or no post-discharge follow-up were excluded. Baseline demographic and clinical characteristics, indication for tube thoracostomy, number of chest tubes, reason for discharge with chest tube, duration of tube placement and post-discharge complications were recorded. Patients were followed twice weekly for four weeks. Data were analyzed using SPSS version 23.0, and categorical variables were presented as frequencies and percentages. Results: The mean age of patients was 38.9 ± 14.7 years. Most patients were male 47, 68.1%), while 22 (31.9%) were female. The commonest indications for emergency tube thoracostomy were traumatic chest injury 21 (30.4%), pneumothorax 17 (24.6%) and haemothorax 12 (17.4%). Most patients 58 (84.1%) were discharged with one chest tube. Empyema thoracis developed in 16 (23.2%) patients during four-week follow-up. Empyema was significantly more frequent among patients discharged with two chest tubes than one chest tube (45.5% vs. 19.0%; p=0.048) and among patients with chest tube duration >14 days compared with ≤14 days (41.7% vs. 13.3%; p=0.012). Other complications included tube-site pain in 18 (26.1%), tube blockage in 9 (13.0%), peritubal leakage in 7 (10.1%), and readmission in 10 (14.5%). Conclusion: Empyema thoracis occurred in nearly one-fourth of patients discharged with a chest tube in situ after emergency tube thoracostomy. Prolonged chest tube duration and discharge with two chest tubes were significantly associated with empyema, highlighting the need for structured discharge criteria, patient education, aseptic tube care and close outpatient follow-up.

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