Asian Journal of Research in Surgery

Background: Pleural empyema is a common and often fatal illness that causes one million hospitalizations worldwide each year. Considering its link to substantial morbidity as well as perioperative and anesthetic mortality, the judicial use of surgical intervention in all pleural infection cases is required. For patients with pleural infection at presentation, the RAPID score (Renal, Age, Fluid Purulence, Infection source, Dietary [albumin]) is currently a validated scoring system that enables risk stratification. The aim of this research is to evaluate the RAPID score as a predictor of morbidity and death after pulmonary decortication in a retrospective cohort of Bangladeshi patients with pleural empyema.

Materials and Methods: This retrospective study was conducted in Department of Thoracic Surgery of Dhaka Medical College and Hospital, Dhaka, Bangladesh from January 2024 to June 2025. The authors retrospectively analyzed the medical records of the patients from database of thoracic surgery department who had pulmonary decortication for primary empyema during the study period. RAPID score was calculated for each patient after data collection in a preformed questionnaire. However during our study period, the RAPID score was not utilized to determine the clinical management of the patient.

Results: A total number of 27 patients were included in the study after fulfilling the inclusion and exclusion criteria. Mean age was 56±5.2 years with a male female ratio of 2:1. Diabetes mellitus was the most common associated co-morbidities (62.44%). According to the RAPID score, 8 patients (29.62 %) were stratified as low-risk, 10(37.03%) patients as medium-risk and 9 as high-risk (33.33 %). (The high-risk group had a 3-month mortality of 33.33%, while the moderate-risk group had 10 %, and low risk had no deaths within 90 days, showing a good correlation between the RAPID score and 3-month survival (p < 0.05). Rapid score was also correlated to secondary outcomes of our study which was statistically significant (p<0.05). Sensitivity and specificity for the primary endpoint at high-risk score were 92.89% % and 81.82%, respectively. On the other hand, sensitivity for low risk and medium risk group were 89.89% and 95.51% respectively.

Conclusion: The present study demonstrated a strong association between 3-month morbidity and mortality with risk stratification of RAPID scoring system. The results of the current study will help to predict the prognosis of the patients who will receive surgical intervention for pleural empyema.