Clinical outcomes and prognostic factors of open-window thoracostomy for empyema: a retrospective review of 40 patients.

Authors

Toru Kawakami, Hayato Nanami, Kiyomi Shimoda, Miyako Hiramatsu, Kazuhiro Uchimura, Yuji Shiraishi

Published in

Surgery today. Jun 24, 2026. Epub Jun 24, 2026.

Abstract

Open-window thoracostomy remains a traditional yet important option for treating empyema. This study aimed to evaluate the clinical outcomes after open-window thoracostomy and identify any prognostic factors based on our institutional experience.
We retrospectively reviewed the medical records of 40 consecutive patients who underwent open-window thoracostomy at our institution between January 2010 and December 2020.
The mean age of the patients was 68.3 years, and twenty-five were male. Thirty-five patients had empyema with a fistula and five had empyema without a fistula. The overall survival rates at one, three, and five years were 92.5 percent, 72.9 percent, and 55.9 percent, respectively. A univariate Cox regression analysis followed by a multivariate Cox regression analysis identified three independent prognostic factors for overall survival: preoperative contralateral aspiration pneumonia, prognostic nutritional index < 37.4 (area under the curve 0.742 by receiver operating characteristic analyses), and an elevated white blood cell count.
The preoperative nutritional status, systemic inflammation, and the presence of contralateral aspiration pneumonia were strongly associated with survival after open-window thoracostomy. This study highlights the importance of these factors in the management of empyema.

PMID:
42342958
Bibliographic data and abstract were imported from PubMed on 25 Jun 2026.

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