BACKGROUND: In the post-MIST-2 era, conservative-first management of empyema (antibiotics plus drainage with IET) is widely adopted, yet the real-world clinical course and predictors of surgical escalation remain unclear. METHODS: Using HCUP-National Inpatient Sample (2016 through 2018), we identified adults hospitalized with a principal diagnosis of empyema (ICD-10-CM J86.9). We excluded interhospital transfers and cases with an initial invasive pleural procedure. Patients were grouped as (1) conservative only (needle drainage and/or tube thoracostomy and IET) or (2) surgical escalation after initial conservative care. Primary outcomes were escalation to invasive pleural procedures and hospital LOS; secondary outcomes included in-hospital mortality, discharge disposition, and costs. Multivariable logistic regression evaluated factors associated with escalation; negative binomial regression modeled LOS. RESULTS: = 0.001). CONCLUSIONS: Most adults with empyema managed initially with noninvasive pleural procedures did not require invasive escalation during index admission. Escalation was associated with greater procedural burden, longer LOS, and higher costs. IET was associated with lower odds of escalation but slightly longer LOS.
Iqbal et al. (Wed,) studied this question.
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