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2%) and septic shock (15.2%), followed by persistent air leakage for 7 days (9.1%). Twenty-four (75%) of 32 patients had good re-expansion of the affected lung 3 months after VATS decortication. We concluded that VATS decortication in the treatment of thoracic empyema is effective in elderly patients. The major concerns of postoperative complications are respiratory failure and sepsis. We concluded that VATS decortication in the treatment of thoracic empyema is effective in elderly patients. The major concerns of postoperative comp