Sex differences in surgical treatment of pleural empyema: an exploratory retrospective comparison of video-assisted thoracoscopic surgery and thoracotomy

A higher prevalence of intraoperative abscesses was observed in female patients undergoing thoracotomy for pleural empyema, despite a lower burden of systemic comorbidities. Otherwise, outcomes and perioperative parameters were similar between sexes in both surgical groups. These findings are exploratory and hypothesis-generating and should be interpreted with caution. Larger prospective studies with balanced sex representation, standardized staging, and long-term follow-up are warranted to clarify potential sex-related variations in disease manifestation and surgical outcomes. The relatively small female cohort and limited VATS subgroup reduce statistical power and restrict generalizability.