In Dogs With Pyothorax Does Medical Management Alone, Invasive Medical Management, or Surgical Management Result in Better Long-term Outcome?

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Appraisal, application and reflection

All relevant studies identified that discuss the outcome of medical or surgical management of pyothorax, or directly compare outcomes of both medical and surgical canine pyothorax cases, are either retrospective case series, or literature reviews that do not add new information to the literature. Retrospective case series sit low on the hierarchy of evidence, so meaningful clinical conclusions are difficult to draw.

It appears that many cases across these studies are initially medically managed first before escalating to surgical management adding significant bias to their results, and every surgical case appeared to have received medical (either invasive, non-invasive, or both) treatment, therefore it remains prudent to consider that some surgically managed cases may have recovered with medical management alone. Further to this, it appears that pyothorax aetiology is often the deciding factor when it comes to choice of treatment modality, and this alone may bring about variations in survival rates. There also appears to be a wide range of treatment modalities applied in all studies, even between cases within the same patient groups, and there is rarely any mention of criteria for treatment selection.

It appears from consulting the available literature that invasive medical management (thoracic drainage and lavage via in-dwelling thoracostomy tubes and antimicrobial therapy) and surgical management (in conjunction with antimicrobial therapy) of canine pyothorax provide better long-term survival rates compared to non-invasive medical management (antimicrobial therapy, with or without thoracocentesis) alone. However, until higher quality (prospective, randomised, blinded) research directly comparing standardised medical and surgical management of canine pyothorax is made available, it is difficult to draw meaningful conclusions from the available research.

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