Factors Associated with Length of Hospital Stay in Pleural Empyema: A Retrospective Study

Abstract

Objective This study aimed to evaluate clinical, biochemical, microbiological, and treatment-related factors associated with the length of hospital stay in patients with pleural empyema. Material and Method Medical records of patients treated for pleural empyema between 2017 and 2025 were retrospectively reviewed. Demographic characteristics, comorbidities, pleural fluid analyses, microbiological results, and treatment modalities were analyzed. Statistical analyses included the Mann–Whitney U test, Kruskal–Wallis test, and Spearman correlation analysis. Results 58 patients were included (82.8% male; mean age 56.0 ± 16.9 years). Surgical management was applied in 50% of cases. Chronic disease and malignancy were associated with prolonged stay (p = 0.025 and p = 0.038, respectively). Pleural fluid white blood cell levels were positively correlated with length of stay (p= 0.004). Conclusion This study emphasizes the importance of an early, individualized approach to the management of pleural empyema. Elevated pleural inflammatory markers and the presence of chronic disease or malignancy were associated with prolonged hospitalization. Inflammatory burden and accompanying comorbidities should be considered when selecting treatment strategies in empyema management.

Keywords

• Empyema
• Pleural Drainage
• Pleural Effusion
• Thoracic Surgery

Supporting Institution

This study was supported by the Scientific Research Projects Coordination Unit of Suleyman Demirel University with project code TSG-2023-9010.

Project Number

TSG-2023-9010

Ethical Statement

Ethical Approval The study was conducted following the approval (No: 107/31; dated 09.12.2025) of the Suleyman Demirel University Health Sciences Ethics Committee. The study was conducted in accordance with the ethical principles stated in the Declaration of Helsinki of the World Medical Association (WMA). Consent to Participate and Publish Written informed consent to participate and publish waived due to retrospective nature of the study.

References

1. 1. Roberts ME, Rahman NM, Maskell NA, Bibby AC, Blyth KG, Corcoran JP, et al. British Thoracic Society guideline for pleural disease. Thorax 2023;78(Suppl 3):s1–42.
2. 2. Bedawi EO, Hassan M, Rahman NM. Recent developments in the management of pleural infection: a comprehensive review. Clin Respir J. 2018;12(8):2309–20.
3. 3. McCauley L, Dean N. Pneumonia and empyema: causal, casual or unknown. J Thorac Dis. 2015;7(6): 992- 998.
4. 4. Shen KR, Bribriesco A, Crabtree T, Denlinger C, Eby J, Eiken P, et al. The American Association for Thoracic Surgery consensus guidelines for the management of empyema. J Thorac Cardiovasc Surg. 2017;153(6):e129–46.
5. 5. Alioke II, Delia IZ, Edaigbini SA, Etiuma AU. Prognostic factors in the management of empyema thoracis in Northern Nigeria. J West Afr Coll Surg. 2022;12(4):75-81.
6. 6. Frank S, Pedro DN, Scott JS. Benign pleural diseases: empyema thoracis. In: Sellke FW, del Nido PJ, Swanson SJ, eds. Sabiston and Spencer Surgery of the Chest. 9th ed. Elsevier; 2015:467-475.
7. 7. Zhao T, Zhang J, Zhang X, Wang C. Clinical significance of pleural fluid lactate dehydrogenase/adenosine deaminase ratio in the diagnosis of tuberculous pleural effusion. BMC Pulm Med. 2024;24(1):241.
8. 8. Soriano T, Alegre J, Alemán C, Ruiz E, Vázquez A, Carrasco JL, et al. Factors influencing length of hospital stay in patients with bacterial pleural effusion. Respiration 2005;72(6):587–93.

9. 9. Alegre J, Suriñach JM, Varela E, Armadans L, Marti R, Segura R, et al. Diagnostic accuracy of pleural fluid polymorphonuclear elastase in the differentiation between pyogenic bacterial infectious and non-infectious pleural effusions. Respiration 2000;67(4):426–32.
10. 10. Alemán C, Alegre J, Segura RM, Armadans L, Suriñach JM, Varela E, et al. Polymorphonuclear elastase in the early diagnosis of complicated pyogenic pleural effusions. Respiration 2003;70(5):462–7.
11. 11. Rogovskii V. Cancer and autoimmune diseases as two sides of chronic inflammation and the method of therapy. Curr Cancer Drug Targets 2024;24(11):1089–103.
12. 12. Lian J, Yue Y, Yu W, Zhang Y. Immunosenescence: a key player in cancer development. J Hematol Oncol. 2020;13(1):151.
13. 13. Karandashova S, Florova G, Idell S, Komissarov AA. From Bedside to the Bench—A Call for Novel Approaches to Prognostic Evaluation and Treatment of Empyema. Front Pharmacol. 2022;12:806393.
14. 14. Liu CC, Chen YL, Cheng CY, Huang CL, Hung WH, Wang BY. Risk factors and prognostic predictors of recurrent bacterial empyema in patients after surgical treatment. BMC Infect Dis. 2025;25(1):667.
15. 15. Stankey CT, Spaulding AB, Doucette A, Hamre KES, Wheeler W, Pomputius WF, Kurachek S. Blood culture and pleural fluid culture yields in pediatric empyema patients: a retrospective review, 1996–2016. Pediatr Infect Dis J. 2018;37(9):952-954.
16. 16. Dyrhovden R, Eagan TM, Kommedal Ø. Pleural infection: contemporary microbiology completing the picture. Clin Infect Dis. 2024;79(6):1533-1534.
17. 17. Elsheikh A, Rahman NM, Bedawi EO. Medical treatment of empyema. In: Yarmus L, Ernst A, Herth F, editors. Principles and Practice of Interventional Pulmonology. Cham: Springer; 2026. doi:10.1007/978-3-031-80466-3_75
18. 18. Rahman NM, Bedawi EO, Elsheikh A. Surgery versus intrapleural fibrinolysis for management of complicated pleural infections: a systematic review and meta-analysis. Respir Res. 2024;25(1):323.
19. 19. Scarci M, Abah U, Solli P, Page A, Waller D, Van Schil P, et al. EACTS expert consensus statement for surgical management of pleural empyema. Eur J Cardiothorac Surg. 2015;48(5):642-653.