| Sažetak | 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. |
| Sažetak (hrvatski) | Cilj: Cilj predstavljene studije bio je analizirati kliničke podatke pacijenata starijih od 75 godina s dijagnozom pleuralnog empiema hospitaliziranih u Regiomed klinikama te procijeniti i usporediti ishode različitih metoda liječenja s obzirom na čimbenike koji utječu na loš prognostički ishod, i važnost korištenja RAPID Score sustava.
Materijali i metode: Pacijenti koji su bili hospitalizirani između siječnja 2017. i svibnja 2023. u jednoj od REGIOMED bolnica: Coburg, Lichtenfels, Sonneberg, Hildburghausen, Neustadt bei Coburg s dijagnozom pleuralnog empiema u fazi I, II ili III uključeni su u ovu retrospektivnu studiju. Fokus je bio na pacijentima starijima od 75 godina. Analiziran je ishod pacijenata s obzirom na smrtnost u bolnici nakon minimalno invazivne operacije, loše prognostičke čimbenike (smrtnost u bolnici, duljina boravka u bolnici, ponovni prijem zbog recidiva ili slijedeće bolesti, preživljenje nakon jedne godine). Konačno, raspravljana je učinkovitost RAPID dijagnostike u sprječavanju dodatne terapije.
Rezultati: Pleuralni empiem je ozbiljno stanje, posebno kod starijih pacijenata koji često imaju teške komorbiditete, što dovodi do ozbiljnijeg kliničkog tijeka. Naša studija analizirala je 344 pacijenta, od kojih je 110 bilo starije od 75 godina, s fokusom na 108 njih zbog potpunih podataka. Kirurško liječenje putem VATS-a pokazalo je stopu preživljavanja od 89,5% kod starijih pacijenata, što ukazuje na prednosti kirurške intervencije u ovoj dobnoj skupini. Čimbenici poput spola, promjene antibiotika, početne terapije, multimorbiditeta i imunosupresije analizirani su radi utjecaja na smrtnost u bolnici, trajanje boravka u bolnici, stope ponovnog prijema i jednogodišnje preživljenje. Iako nijedan od ovih čimbenika nije značajno predvidio smrtnost u bolnici, kasna početna terapija značajno je povećala trajanje boravka u bolnici, a superinfekcija je značajno povećala stope ponovnog prijema. Multimorbiditet je pokazao trend smanjenja izgleda za jednogodišnje preživljenje. Konačno, RAPID skor učinkovito je predvidio smrtnost u bolnici, ali ne i druge ishode. To sugerira da, iako nizak RAPID skor ukazuje na manji rizik od smrti u bolnici, treba ga koristiti za identifikaciju pacijenata koji bi mogli imati koristi od ranih intervencija za poboljšanje šansi za oporavak.
Zaključak: Ova studija pokazuje da starija dob nije kontraindikacija za kiruršku terapiju pleuralnog empiema, s obzirom na dobre stope preživljavanja i ograničene faktore koji utječu na loše ishode u ovoj populaciji. Pravovremeni početak liječenja je ključan za određivanje duljine boravka u bolnici, što naglašava potrebu za učinkovitim ranim intervencijama. Imunosupresija igra značajnu ulogu u ishodima, a rješavanje komorbiditeta je bitno za poboljšanje zdravstvenih ishoda kod starijih pacijenata. Studija je pokazala da, iako većina varijabli nije bila statistički značajna, starija dob i imuni status ne bi trebali biti prepreke za uspješno liječenje. RAPID zbir se pokazao korisnim prediktorom ishoda, podržavajući ideju da stariji pacijenti s pleuralnim empiemom mogu imati koristi od kirurškog liječenja. Sveukupno, nalazi sugeriraju da čak i starije pacijente s teškim stanjima vrijedi liječiti, uključujući kirurški, uz odgovarajuće intervencije. |
