Background: Aim of the study to determine if the size of the chest drain matters on thoracic empyema therapy. Also to analyze the aetiologic factors, management and strategy for surgery, morbidity and mortality. Material and Methods: In a 21year period a retrospective study took place. One hundred seventy four (174) patients treated for thoracic empyema, at Thoracic Surgery Department at General Hospital of Nicaea-Piraeus Agios Panteleimon –Greece. Results: During a 21year period (from 1998 to 2019) one hundred seventy four (174) patients diagnosed with thoracic empyema, 119 male (68,713%) and 55 female (31,609 %), aged 19-91 years mean age 47 years.Most of the developed empyemas were post pneumonia. The two most common were Streptococcus pneumoniae and Staphylococcus aureus. Almost all patients had developed already purulent effusion (not early empyema) due to late referral to our department. All patients underwent chest drain insertion. One hundred sixteen patients (116) received chest drain (tube or pleural cath) insertion and medication (antibiotics /antibiogram, antipyretics, nebulizers) and physiotherapy, had uneventful recovery.The rest of the population group 58 (33,333%) underwent surgery. All 174 patients received initially chest drains.The majority 135 underwent chest drain 28F most of them and a few 32F. One third of them 46(34,074%) underwent thoracotomy and decortication.Thirtyeight(38) patients underwent tiny drain insertion 14F pleural cath. One third almost 12 (31,578%) underwent surgery too.Elderly patients had longer stay in the hospital comparative to younger group of population. Conclusion: The right drainage of the purulent pleural cavity is crucial. The size of the drain does not matter. Only one third underwent surgery. Most of the developed empyemas were post pneumonia. Streptococcus pneumoniae and Staphylococcus aureus were the most common bacteria.Elderly patients had longer stay in the hospital comparative to younger group of population.
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