BACKGROUND: Prompt initiation of antibiotics and drainage of infection source is essential in the management of pleural cavity infection. Although surgical drainage is considered a gold standard of treatment for unresolved parapneumonic infection, optimal timing for surgical intervention is still under debate. Thus, we seek to analyze the clinical outcomes of urgent thoracoscopic surgery for complicated parapneumonic effusion regarding the duration of preoperative antibiotic usage. METHODS: Medical records were retrospectively reviewed for patients who received thoracoscopic surgery for complicated parapneumonic effusion or empyema. Patients were grouped according to the preoperative antibiotic durations and compared. Group A consists of the patients with less than 3 days of preoperative antibiotics usage and Group B consists of those with more than 3 days of preoperative antibiotic coverage. Basic demographics, preoperative chest computed tomography (CT) findings, antibiotics usage, duration until surgery and treatment outcomes were evaluated. RESULTS: From February 2008 to November 2018, a total of 180 patients underwent video-assisted thoracoscopic surgery (VATS) for pleural drainage or decortication of lung. Group A patients had higher C-reactive protein value (240 CONCLUSIONS: Faster and relatively safe and successful clinical outcomes can be achieved with urgent thoracoscopic surgery on patients with complicated parapneumonic effusion despite limited duration of antibiotics coverage.