ObjectivesTo evaluate the effects of video-assisted thoracoscopic decortication (VATD) and enhanced recovery after surgery (ERAS) in patients with stage III tuberculous empyema.MethodsThe 360 participants were divided into four groups according to the treatment received: thoracotomy decortication (TD) + traditional recovery procedures (TRP), TD + ERAS, VATD + TRP, and VATD + ERAS. We evaluated the effects of the treatment modalities on various intraoperative and postoperative outcome measures. Multivariate analysis was then performed to identify risk factors associated with increased postoperative the length of hospital (LOS).ResultsThere were significant differences between the TD and VATS groups in terms of the duration of surgery, intraoperative blood loss, postoperative drainage, postoperative erythrocyte sedimentation rate (ESR), LOS, and pain levels. The use of ERAS also showed significant effects in certain outcome measures. There were no significant differences in the incidence of postoperative complications among the groups. The use of VATD and ERAS procedures, and preoperative antituberculosis therapy, was inversely associated with the LOS.ConclusionsImplementation of VATD and ERAS procedures in patients with stage III tuberculous empyema can significantly reduce the LOS and improve patient outcomes in a safe and effective manner.