{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T15:06:32Z","timestamp":1791644792356,"version":"4.3.4"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Private Universit\u00e4t Witten\/Herdecke gGmbH"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Cardiothorac Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pleural empyema is a serious complication of pulmonary infections that often requires surgical intervention . This study compared outcomes between video-assisted thoracoscopic Surgery (VATS) and thoracotomy, with particular attention to postoperative complications, intensive care unit (ICU) admission rates, and intraoperative parameters. The aim was to evaluate associations between surgical approach and perioperative outcomes in routine clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 103 patients who underwent surgical management for pleural empyema at a university thoracic surgery department between December 2019 and May 2024. Nineteen patients (18.4%) underwent VATS, and 84 patients (81.6%) underwent thoracotomy. The surgical approach was determined based on disease stage and intraoperative surgical assessment. Primary outcomes included postoperative complications and ICU admissions, while secondary outcomes included transfusion requirements and operative duration. Ethical approval was obtained prior to study initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Complications occurred significantly less frequently following VATS than after thoracotomy (10.5% vs. 51.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005). ICU admissions were also less common in the VATS group (57.9% vs. 86.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005). No patients in the VATS group required transfusions, whereas 28.6% patients in the thoracotomy group did (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.057). Operative time did not differ significantly between the groups (VATS: 99.6\u00a0min; thoracotomy: 116.4\u00a0min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.181). Intraoperative pathogen detection rates were similar (OR 0.88, 95% CI: 0.301\u20132.544,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.807).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this retrospective cohort, VATS was associated with lower rates of postoperative complications and ICU admissions compared with thoracotomy in appropriately selected patients. Thoracotomy remains essential indispensable in advanced disease requiring extensive decortication, likely reflecting underlying disease severity rather than the surgical approach itself . Given the retrospective design and imbalance in group sizes , these findings should be interpreted with caution. Prospective multicenter studies are needed to confirm these findings and refine surgical decision-making criteria.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13019-026-03992-3","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T13:25:14Z","timestamp":1775654714000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Video-Assisted Thoracoscopic Surgery Versus Thoracotomy for Pleural Empyema: Outcomes and Risk Factors in a Retrospective Single-Center Cohort Study"],"prefix":"10.1186","volume":"21","author":[{"given":"Josef","family":"Yayan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr","family":"Khalil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Kr\u00fcger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Biancosino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"issue":"3","key":"3992_CR1","doi-asserted-by":"publisher","first-page":"CD010651","DOI":"10.1002\/14651858.CD010651.pub2","volume":"3","author":"MD Redden","year":"2017","unstructured":"Redden MD, Chin TY, van Driel ML. Surgical versus non-surgical management for pleural empyema. Cochrane Database Syst Rev. 2017;3(3):CD010651. https:\/\/doi.org\/10.1002\/14651858.CD010651.pub2. PMID: 28304084; PMCID: PMC6464687.","journal-title":"Cochrane Database Syst Rev"},{"issue":"11","key":"3992_CR2","doi-asserted-by":"publisher","first-page":"1421","DOI":"10.1111\/1759-7714.12854","volume":"9","author":"D Chen","year":"2018","unstructured":"Chen D, Mao R, Kadeer X, Sun W, Zhu E, Peng Q, Chen C. Video-assisted thoracic surgery is an optimal alternative to conventional thoracotomy for reoperations for ipsilateral pulmonary lesions. Thorac Cancer. 2018;9(11):1421\u20138. https:\/\/doi.org\/10.1111\/1759-7714.12854. PMID: 30152592; PMCID: PMC6209788.","journal-title":"Thorac Cancer"},{"issue":"2","key":"3992_CR3","doi-asserted-by":"publisher","first-page":"70","DOI":"10.21037\/jtd.2020.01.22","volume":"12","author":"M Mazzei","year":"2020","unstructured":"Mazzei M, Abbas AE. Why comprehensive adoption of robotic assisted thoracic surgery is ideal for both simple and complex lung resections. J Thorac Dis. 2020;12(2):70\u201381. https:\/\/doi.org\/10.21037\/jtd.2020.01.22. PMID: 32190356; PMCID: PMC7061192.","journal-title":"J Thorac Dis"},{"issue":"4","key":"3992_CR4","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1183\/20734735.025718","volume":"14","author":"D Subotic","year":"2018","unstructured":"Subotic D, Lardinois D, Hojski A. Minimally invasive thoracic surgery for empyema. Breathe (Sheff). 2018;14(4):302\u201310. https:\/\/doi.org\/10.1183\/20734735.025718. PMID: 30519296; PMCID: PMC6269178.","journal-title":"Breathe (Sheff)"},{"issue":"9","key":"3992_CR5","doi-asserted-by":"publisher","first-page":"618","DOI":"10.4103\/0019-5049.165852","volume":"59","author":"S Sengupta","year":"2015","unstructured":"Sengupta S. Post-operative pulmonary complications after thoracotomy. Indian J Anaesth. 2015;59(9):618\u201326. https:\/\/doi.org\/10.4103\/0019-5049.165852. PMID: 26556921; PMCID: PMC4613409.","journal-title":"Indian J Anaesth"},{"issue":"3","key":"3992_CR6","doi-asserted-by":"publisher","first-page":"125","DOI":"10.5090\/kjtcs.2019.52.3.125","volume":"52","author":"L Mohajerzadeh","year":"2019","unstructured":"Mohajerzadeh L, Lotfollahzadeh S, Vosoughi A, Harirforoosh I, Parsay S, Amirifar H, Farahbakhsh N, Atqiaee K. Thoracotomy versus video-assisted thoracoscopy in pediatric empyema. Korean J Thorac Cardiovasc Surg. 2019;52(3):125\u201330. PMID: 31236371; PMCID: PMC6559187.","journal-title":"Korean J Thorac Cardiovasc Surg"},{"issue":"9","key":"3992_CR7","doi-asserted-by":"publisher","first-page":"863","DOI":"10.7150\/ijms.8912","volume":"11","author":"J Yang","year":"2014","unstructured":"Yang J, Xia Y, Yang Y, Ni ZZ, He WX, Wang HF, Xu XX, Yang YL, Fei K, Jiang GN. Risk factors for major adverse events of video-assisted thoracic surgery lobectomy for lung cancer. Int J Med Sci. 2014;11(9):863\u20139. https:\/\/doi.org\/10.7150\/ijms.8912. PMID: 25013365; PMCID: PMC4081307.","journal-title":"Int J Med Sci"},{"issue":"9","key":"3992_CR8","doi-asserted-by":"publisher","first-page":"e45367","DOI":"10.7759\/cureus.45367","volume":"15","author":"IS Al-Githmi","year":"2023","unstructured":"Al-Githmi IS, Alotaibi A, Habeebullah A, Bajunaid W, Jar S, Alharbi NA, Aziz H. Postoperative pulmonary complications in patients undergoing elective thoracotomy versus thoracoscopic surgeries. Cureus. 2023;15(9):e45367. https:\/\/doi.org\/10.7759\/cureus.45367. PMID: 37849610; PMCID: PMC10578611.","journal-title":"Cureus"},{"issue":"4","key":"3992_CR9","doi-asserted-by":"publisher","first-page":"1460","DOI":"10.21037\/jtd.2020.02.29","volume":"12","author":"LB van Middendorp","year":"2020","unstructured":"van Middendorp LB, Franssen S, Gillissen S, Maessen JG, Hulsew\u00e9 KWE, Vissers YLJ, de Loos ER. Uniportal video-assisted thoracoscopy is a safe approach in patients with empyema requiring surgery. J Thorac Dis. 2020;12(4):1460\u20136. https:\/\/doi.org\/10.21037\/jtd.2020.02.29. PMID: 32395283; PMCID: PMC7212173.","journal-title":"J Thorac Dis"},{"key":"3992_CR10","doi-asserted-by":"publisher","unstructured":"Reichert M, P\u00f6sentrup B, Hecker A, Schneck E, Pons-K\u00fchnemann J, Augustin F, Padberg W, \u00d6fner D, Bodner J. Thoracotomy versus video-assisted thoracoscopic surgery (VATS) in stage III empyema: an analysis of 217 consecutive patients. Surg Endosc. 2018;32(6):2664\u20132675. https:\/\/doi.org\/10.1007\/s00464-017-5961-7. 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PMID: 19379898.","DOI":"10.1016\/j.athoracsur.2009.01.028"}],"container-title":["Journal of Cardiothoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13019-026-03992-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-026-03992-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-026-03992-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T21:38:05Z","timestamp":1781645885000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13019-026-03992-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,8]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3992"],"URL":"https:\/\/doi.org\/10.1186\/s13019-026-03992-3","relation":{},"ISSN":["1749-8090"],"issn-type":[{"value":"1749-8090","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,8]]},"assertion":[{"value":"22 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the institutional Ethics Commission. The Commission reviewed and approved the study\u2019s design, methodology, and ethical considerations, with particular attention to patient safety, data confidentiality, and compliance with the General Data Protection Regulation (GDPR). Due to the retrospective nature of the study, the requirement for written informed consent was waived where applicable. All data were fully anonymized, and the study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The study received approval from the Institutional Review Board (IRB).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"We confirm that all materials included in this manuscript can be published.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"No generative artificial intelligence (AI) tools were used in the research design, data analysis, or writing of this manuscript. All content was generated by the authors without the assistance of AI-based technologies.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Artificial intelligence usage"}}],"article-number":"187"}}