Introduction: Pleural empyema is a collection of pus in the area between the lungs and the inner surface of the chest wall that is caused by microorganisms, usually bacteria. Prompt evacuation of the infected fluid along with appropriate antibiotics is the mainstay treatment; however, Decortication may be performed with percutaneous chest tube placement. Objective: The objective of the study is to determine the clinical outcomes of surgical decortication as first line treatment of choice in pleural empyema. Material and Method: The study is an observational retrospective analysis of 100 patients who presented with empyema and were treated either with open drainage or surgical decortications as the first line of treatment at Dhiraj General Hospital, Gujarat. Results: Out of 100 patients with empyema 27 underwent open drainage and 73 with surgical decortications. Surgical decortications showed a better treatment success rate in all study subjects (68/73 patients, 93%) compared with open drainage (20/27 patients, 74%, p<.001 for method comparison). After a propensity scored matching surgical decortications resulted in a better outcome versus open drainage, hence surgical decortication was the best predictor of treatment of success. Conclusion: The first treatment of choice for pleural empyema is critical determinant of ultimate therapeutic success. After adjusting for confound variables, surgical decortication is the optimal first treatment of choice in advanced empyema.

Keywords: Pleural empyema; Decortication; Tuberculosis.