Delayed Referral and Gram-Negative Organisms Increase the Conversion Thoracotomy Rate in Patients Undergoing Video-Assisted Thoracoscopic Surgery for Empyema

Video-assisted thoracoscopic debridement offers an elegant, minimally invasive approach in a number of patients with presumed stage II empyema. However, to achieve a high success rate with the video-assisted thoracoscopic approach, early referral of the patients to surgery is required. Conversion thoracotomy should be liberally used in case of chronicity, especially after delayed referral (>2 weeks) and in the presence of gram-negative organisms.