Title: The impact of geriatric patients on outcome in septic thoracic surgery outside academic institutions: An investigation of risk factors and postoperative courses. Objectives: The aim of the presented study was to analyze clinical data of patients aged over 75 years with diagnosis of pleural empyema hospitalized at the Regiomed Clinics and to evaluate and compare outcomes of different treatment methods with regards factors that influence bad prognostic outcome and the importance of using RAPID Score system. Materials and methods: Patients who were hospitalized between January 2017 and May 2023 in one of the REGIOMED hospitals: Coburg, Lichtenfels, Sonneberg, Hildburghausen, Neustadt bei Coburg with diagnosis of pleural empyema in stage I, II, or III were included in this retrospective study. Focus was on patients aged over 75 years of age. Patient outcome in regards of in hospital mortality after minimal invasive surgery, bad prognostic factors (in hospital mortality, length of hospital stay, readmission due to recurrence or following disease, survival after one year) was analyzed. Finally, effectiveness of RAPID diagnostic in preventing additional therapy was discussed. Results: Pleural empyema is a serious condition, especially in older patients who often have severe comorbidities, leading to a more severe clinical course. Our study analyzed 344 patients, with 110 over the age of 75, focusing on 108 of these due to complete data. Surgical treatment via VATS showed an 89.5% survival rate in elderly patients, demonstrating the benefits of surgical intervention in this age group. Factors like gender, antibiotic changes, initial therapy, multimorbidity, and immunosuppression were analyzed for their impact on in-hospital mortality, hospital stay duration, readmission rates, and one-year survival. While none of these factors significantly predicted in-hospital mortality, late initial therapy significantly increased hospital stay duration, and superinfection significantly increased readmission rates. Multimorbidity showed a trend toward reducing one-year survival odds. Finally, the RAPID score effectively predicted in-hospital mortality but not other outcomes. This suggests that while a low RAPID score indicates a lower risk of in-hospital death, it should be used to identify patients who might benefit from early interventions to improve recovery chances. Conclusion: This study demonstrates that advanced age is not a contraindication to surgical therapy for pleural empyema, given the good survival rates and the limited factors influencing poor outcomes in this population. Timely initiation of treatment is crucial in determining hospital stay lengths, highlighting the need for effective early interventions. Immunosuppression plays a significant role in outcomes, and addressing comorbid conditions is essential for improving health outcomes in elderly patients. The study found that while most variables were not statistically significant, advanced age and immune status should not be seen as barriers to successful treatment. The RAPID Score proved to be a useful predictor of outcomes, supporting the notion that elderly patients with pleural empyema can benefit from surgical treatment. Overall, the findings suggest that even elderly patients with severe conditions are worth treating, including surgically, with appropriate interventions.