The American Association for Thoracic Surgery consensus guidelines for the management of empyema

Central MessageThe study objective was to establish The American Association for Thoracic Surgery (AATS) evidence-based guidelines for the management of empyema.See Editorial Commentary page e147. The study objective was to establish The American Association for Thoracic Surgery (AATS) evidence-based guidelines for the management of empyema. See Editorial Commentary page e147. The study objective was to establish The American Association for Thoracic Surgery (AATS) evidence-based guidelines for the management of empyema. The AATS Guidelines Committee selected management of empyema as a topic suitable for creation of a clinical guideline, and co-chairs (K. Robert Shen, MD, and Benjamin Kozower, MD, thoracic surgeons) were appointed and asked to form an Empyema Management Guidelines Working Group who would create empyema management guidelines for the AATS Guidelines Committee by April 2015. The co-chairs assembled a multidisciplinary group of experts including 5 thoracic surgeons, 1 interventional radiologist, 1 infectious disease specialist, and 1 interventional pulmonologist. Members were tasked with performing comprehensive literature searches and making recommendations based on a review of the literature. Members also graded the quality of the evidence supporting the recommendations and with assessing the risk-benefit profile for each recommendation. The level of evidence (LOE) was graded by the work force panel according to standards published by the Institute of Medicine (IOM; Figure 1). For the development of the guidelines, we consulted the recommendations of IOM 2011 Clinical Practice Guidelines We Can Trust: Standards for Developing Trustworthy Clinical Practice Guidelines (www.iom.edu/cpgstandards)1Institute of Medicine. Clinical practice guidelines we can trust. Available at: http://iom.nationalacademies.org/reports/2011/clinical-practice-guidelines-we-can-trust.aspx. 2011. Accessed December 6, 2015.Google Scholar and followed the IOM recommendations without patient engagement. Three scheduled teleconferences were used to organize the topics to be covered by the guidelines and review the literature review summaries and proposed recommendations. All meetings had agendas circulated beforehand and minutes circulated afterward. All of the conference calls were recorded by the AATS staff to improve transcription of notes. A 1-day face-to-face conference was then held to formally vote on the final recommendations to present to the Councilors of the AATS and review the final manuscript. All recommendations were subjected to a vote. Acceptance for the final document required greater than 75% approval of each of the recommendations. The following recommendations are based on the best available evidence. When high-quality evidence was lacking, we present the best expert opinion based on best practices. An executive summary of these recommendations was prepared for publication in The Journal of Thoracic & Cardiovascular Surgery. A more extensive version of the guideline was prepared for online publication with additional data and a comprehensive list of references.