Impact of drainage strategies on recovery in Stage III tuberculous empyema: a retrospective study

Abstract

Introduction: Tuberculous empyema, a severe complication of pulmonary tuberculosis, often requires surgical intervention in stage III to remove fibrotic tissue and restore lung function.

Methodology: This retrospective study enrolled 224 stage III tuberculous empyema patients undergoing single-port thoracoscopic decortication and closed chest drainage. Patients were divided into three groups: Single-Tube group (n = 42), Double-Tube group (n = 51), and Double-Tube with Negative Pressure (Double-NP) group (n = 131, with -8 to -10 cm H₂O negative pressure applied from postoperative day 2). Primary outcomes included postoperative drainage volume, chest tube duration, hospital stay, complications, and Visual Analog Scale (VAS) pain scores. Data were analyzed using Analysis of Variance (ANOVA), chi-square tests, and multivariate regression.

Results: Baseline characteristics were comparable across groups. Postoperative drainage volumes were similar, but chest tube duration and hospital stay were significantly shorter in the Double-Tube and Double-NP groups compared to the Single-Tube group (p < 0.05). The Double-NP group exhibited lower rates of persistent air leak, pleural effusion, atelectasis, and reintubation (p < 0.05). VAS scores were significantly lower in the Single-Tube group than in the Double-Tube and Double-NP groups (p < 0.01).

Conclusions: While the double-tube with delayed low-negative-pressure drainage strategy did not reduce postoperative pain, it significantly shortened chest tube duration and hospital stay while reducing complications, thereby improving overall prognosis in stage III tuberculous empyema patients.