Evaluation of the RAPID score as a predictor of postoperative morbidity and mortality in patients undergoing pulmonary decortication for stage III pleural empyema

Abstract

Objective:

This study aims to correlate the RAPID score with the 3-month survival and surgical results of patients undergoing lung decortication with stage III pleural empyema.

Methods:

This was a retrospective study with the population of patients with pleural empyema who underwent pulmonary decortication between January 2019 and June 2022. Data were collected from the institution’s database, and patients were classified as low, medium, and high risk according to the RAPID score. The primary outcome was 3-month mortality. Secondary outcomes were the length of hospital stay, readmission rate, and the need for pleural re-intervention.

Results:

Of the 34 patients with pleural empyema, according to the RAPID score, patients were stratified into low risk (23.5 %), medium risk (47.1 %), and high risk (29.4 %). The high-risk group had a 3-month mortality of 40 %, while the moderate-risk group hada 6.25 % and the low-risk group had no deaths within 90days, confirmingagood correlation with the RAPID score (p < 0.05). Sensitivity and specificity for the primary outcome in the high-risk score were 80.0 % and 79.3%, respectively. The secondary outcomes did not reach statistical significance.

Conclusions:

In this retrospective series, the RAPID score had a good correlation with 3-month mortality in patients undergoing lung decortication. The morbidity indicators did not reach statistical significance. The present data justifies further studies to explore the capacity of the RAPID score to be used as a selection tool for treatment modality in patients with stage III pleural empyema.

Keywords:
Empyema; Rapid score; Parapneumonic effusion; Surgery outcomes; Pleural disease

HIGHLIGHTS

This study establishes a strong correlation between the RAPID score and 3-month mortality in patients undergoing lung decortication for pleural empyema.

Patients were stratified into low, medium, and high-risk groups based on the RAPID score, demonstrating that this approach can be valuable in identifying patients with a higher likelihood of complications. This can inform treatment planning and post-operative monitoring.

While the results suggest a strong correlation, prospective studies are needed to fully validate the use of the RAPID score in this population. This underscores the importance of future clinical research to enhance the selection of the initial treatment for patients with pleural empyema.