Video-Assisted Thoracoscopic Surgery Versus Thoracotomy for Pleural Empyema: Outcomes and Risk Factors in a Retrospective Single-Center Cohort Study

Pleural empyema is a serious complication of pulmonary infections that often requires surgical intervention . This study compared outcomes between video-assisted thoracoscopic Surgery (VATS) and thoracotomy, with particular attention to postoperative complications, intensive care unit (ICU) admission rates, and intraoperative parameters. The aim was to evaluate associations between surgical approach and perioperative outcomes in routine clinical practice. We retrospectively reviewed 103 patients who underwent surgical management for pleural empyema at a university thoracic surgery department between December 2019 and May 2024. Nineteen patients (18.4%) underwent VATS, and 84 patients (81.6%) underwent thoracotomy. The surgical approach was determined based on disease stage and intraoperative surgical assessment. Primary outcomes included postoperative complications and ICU admissions, while secondary outcomes included transfusion requirements and operative duration. Ethical approval was obtained prior to study initiation. Complications occurred significantly less frequently following VATS than after thoracotomy (10.5% vs. 51.2%, p = 0.005). ICU admissions were also less common in the VATS group (57.9% vs. 86.9%, p = 0.005). No patients in the VATS group required transfusions, whereas 28.6% patients in the thoracotomy group did (p = 0.057). Operative time did not differ significantly between the groups (VATS: 99.6 min; thoracotomy: 116.4 min, p = 0.181). Intraoperative pathogen detection rates were similar (OR 0.88, 95% CI: 0.301–2.544, p = 0.807). In this retrospective cohort, VATS was associated with lower rates of postoperative complications and ICU admissions compared with thoracotomy in appropriately selected patients. Thoracotomy remains essential indispensable in advanced disease requiring extensive decortication, likely reflecting underlying disease severity rather than the surgical approach itself . Given the retrospective design and imbalance in group sizes , these findings should be interpreted with caution. Prospective multicenter studies are needed to confirm these findings and refine surgical decision-making criteria.