Thoracotomy for Empyema Thoracis—Relevant as Ever in Children, as Timely Referral is Still a Concern: An Observational Study

Aims and background: There are several options for treating empyema thoracis (ET), ranging from conservative therapies to surgical intervention, depending on the stage of the condition. The optimal management strategy for later stages, particularly stage 3, is still up for debate. Assessing the outcomes of open thoracotomy with decortication (OTD) in pediatric ET patients is the aim of this observational research. Materials and methods: About 74 pediatric patients with advanced ET who had OTD between August 2018 and June 2024 at a tertiary pediatric referral center in Northern India were the subjects of a retrospective investigation. The information on the patients' demographics, clinical presentation, microbiological results, surgical specifics, and postoperative results was analyzed. Results: The patients, who were mostly male and had an average age of 4.5 years, were diagnosed with ET. Their main symptoms included fever, coughing, dyspnea, and chest pain. An average of 18.27 days passed between the insertion of the intercostal drainage (ICD) tube and surgery, and 24.18 days passed between the onset of symptoms and their presentation. During surgery, thick pleural peel removal was routinely performed, and bronchopleural fistulas developed in a small percentage of patients. Necrotizing lung tissue loss occurred in four patients. Most patients had a short hospital stay, were in an afebrile state, and had a speedy recovery after surgery. The rare problems that were documented during follow-up included two cases of infection at the surgical site and two cases of postoperative fever. Conclusion: OTD is still an effective therapy for children diagnosed with severe ET, as it carries a small risk of morbidity and death and yields favorable outcomes. Clinical significance: OTD is crucial, even in settings with scarce resources and limited access to modern surgical equipment.