Tracking the outcomes of surgical treatment of Stage 2 and 3 empyema: introduction and consolidation of minimally invasive approach.

Background: We described the results of surgical treatment of empyema, tracing outcomes throughout the passage from the open thoracotomy (OT) approach to video‐assisted thoracoscopic surgery (VATS) in a single institute. Methods: We retrospectively analyzed the records of 88 consecutive patients treated for Stage 2 and 3 empyema (2010–2019). We divided the study period into three groups: OT period (2010–2013), early VATS (2014–2017, from the introduction of VATS program, until acme of learning curve), and late VATS (2018–2019). Groups were compared to investigate the outcomes evolution. Results: Most relevant findings of the study were significant variation in postoperative length of stay (median [interquartile range]: 9 days [7.5–10], 10 [7.5–17.5], and 7 [5–10] for OT period, early VATS, and late VATS, respectively, p = 0.005), hospital admission referral to thoracic surgery interval (7.5 days [4.5–11], 6.5 [3–9], and 2.5 [1.5–5.5], p = 0.003), chest tube duration (5.5 days [5–7.5], 6 [4–6], 4 [3–5], p = 0.003), and proportion of operation performed by residents (3 [15%], 6 [16.7%], 14 [43.6%], p = 0.01). Conclusions: Our findings pictured the trajectory evolution of outcomes during introduction and consolidation of VATS treatment of empyema. During the early phase, we observed a decline in some indicators that improved significantly in the late VATS period. After a learning curve, all outcomes showed better results and we entered into a teaching phase. [ABSTRACT FROM AUTHOR]