Management of pleural empyema: The impact of RAPID score and surgery

The RAPID [Renal (urea level), Age, Pleural fluid purulence, source of Infection and dietary (albumin level)] score classifies patients with pleural infection according to mortality risk at three months. The aim was to evaluate if the RAPID score can aid surgical decision making regarding pleural infections. A retrospective study including all cases of pleural empyema admitted at the thoracic surgery department of Abderrahmene Mami Ariana, over a 10-years period (January 2012 to December 2022). The outcomes were compared between early surgery (≤3 days from diagnosis) and late surgery (>3 days from diagnosis) and low [0-3] vs. high [4-7] RAPID scores. We included 174 patients with a mean age of 44.9 years (04-86 years) and a male predominance (72.3%). The most frequent functional signs were chest pain (96%), fever (85%) and dyspnea (68%). Surgery was indicated for 55% of patients. Video thoracoscopy was performed in 56 patients (2 of whom were converted to posterolateral thoracotomy). The uniportal intervention was used for 11 patients, and video-assisted surgery for the rest. Late surgery was associated with high RAPID score (50.5 % vs 41.6%, P=0.01). High RAPID score was associated with longer length of stay (P= 0.001). High RAPID score with late surgery were associated with longer length of stay (P=0.012). Low RAPID score with early surgery were associated with short length of stay (P= 0.004). There was not a significant association between High RAPID score and mortality. Patients with complicated pleural effusions who had early surgery and low RAPID scores experienced better outcomes and decreased length of stay at hospital. Using the RAPID score represents a real gain in terms of identifying patients who should benefit from early surgery.