Patterns of Thoracic Empyema and Determinants of Surgical Outcomes at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia: A 3-Year Retrospective Cohort Study

Abstract

Background

Management of thoracic empyema remains a major clinical challenge in resource-limited settings. Delays in presentation, inaccurate diagnosis of disease stage, lack of appropriate disease-specific management, and compromised patient status can lead to poor outcomes. This study assessed the clinical profile and patterns and determinants of management outcomes of thoracic empyema patients at Hawassa University Comprehensive Specialized Hospital (HUCSH).

Methods

A retrospective cohort study was conducted on 83 surgical patients managed for thoracic empyema from January 1, 2023, to December 31, 2025. Sociodemographic, clinical presentation, diagnostic method, and management outcome variables were collected. Data were analyzed with SPSS version 26.3. Bivariate and multivariate binary logistic regression was used to identify independent predictors of overall surgical outcomes and predictors of secondary outcomes (reintervention and resolution).

Results

The median age of presentation was 45 years (IQR, 26–64). The majority was male. Forty-five percent had at least one comorbidity, HIV/AIDS being the most common. The median duration of symptoms was 7 weeks (IQR, 5–8). Tuberculosis was the most common etiology of organized stage III empyema. The majority of patients underwent closed chest tube drainage, and 32.5% of cases required open thoracotomy and decortication. About 72.3% of patients had favorable overall surgical outcomes. In-hospital mortality was 14.4%, of which 78.6% had comorbidities. Multivariate binary logistic regression demonstrated that age (AOR = 5.9; 95% CI, 1.6–21.9; P = 0.008), tuberculous empyema (AOR = 5.0; 95% CI, 1.1–7.4; P = 0.034), and presence of comorbidities (AOR = 3.6; 95% CI, 1.0–12.4; P = 0.043) were independent predictors of unfavorable overall surgical outcome. Organized empyema (AOR = 6.4; 95% CI, 1.5–26.3; P = 0.011) and the presence of comorbidities (AOR = 4.1; 95% CI, 1.3–13.4; P = 0.018) were also found to be independent predictors of reintervention and incomplete resolution of empyema respectively.

Conclusion

Etiology, disease stage, and patient condition had a significant impact on thoracic empyema management outcomes in this study. Older age, underlying comorbidities, and tuberculous etiology were associated with unfavorable surgical outcomes. The need for reintervention increased for organized empyema and initial treatment with closed tube drainage. Additionally, comorbidity significantly increased incomplete resolution of empyema. These findings may highlight a crucial insight into patient stratification that could help management decisions improve outcomes in similar settings.