The significance of RAPID scoring in the surgical treatment of empyema

Empyema is a serious clinical condition associated with significant morbidity and mortality. The RAPID scoring system, which has been used as a predictor of in-hospital mortality and length of stay in pleural infections, may serve as a guide in the decision-making process for surgical management of empyema. This retrospective, single-center study was conducted in a thoracic surgery clinic and included adult patients diagnosed with pleural empyema. A total of 81 patients were included in the study. Surgical decortication was performed in 43 patients (53.1%), while 38 patients (46.9%) underwent tube thoracostomy. Video-assisted thoracoscopic surgery (VATS) was preferred in 32 patients (74.4%), whereas thoracotomy was performed in 11 patients (25.6%). The complication rate was higher among patients who underwent surgery in the late period (p = 0.044). The duration of tube thoracostomy follow-up, intensive care unit stay, and overall hospitalization were longer in patients who underwent late surgery (p < 0.001) (p = 0.006) (p < 0.001). The number of surgically treated patients was higher in the low RAPID risk group, while the number of non-surgically managed patients was higher in the high-risk group (p = 0.007). Although the median survival times of the low- and intermediate-risk groups differed notably from the high-risk group, no statistically significant difference was found among the three groups (t = 3.190, p = 0.074; Cramér’s V = 0.198, 95% CI [0.00–0.44]). Patients with high RAPID scores had shorter survival durations. RAPID scoring system may reflect an overlap between surgical eligibility criteria and RAPID score components rather than an independent predictive role of the score.