Background. Thoracic empyema is an inflammatory condition of the pleura that can cause many complications and can even threaten people's lives. So, choosing the right treatment method from all available methods can improve the prognosis, reduce costs and post-treatment complications, thus improving the health of patients after the disease. Video-assisted thoracoscopic surgery (VATS) and open thoracotomy are the most commonly used surgical methods. In this study, these two surgical methods have been investigated, in terms of duration of hospitalization, postoperative pain level and the possibility of air leakage (as postoperative complications). Methodology. Patients with thoracic empyema stage II referred (between 2011 and 2020) to the Poursina and Razi Hospital Medical Center, Rasht, Iran were included in a retrospective cohort study. SPSS software and other statistical tests such as the Shapiro-Wilk test, Mann-Whitney non-parametric test, and Chi-square test were used for statistical analysis, and a P-value of less than 0.05 was considered an acceptable value. Results. The investigation on different qualitative and quantitative factors and complications after surgery showed that patients who underwent a VATS procedure had a shorter hospital stay (5.09±1.67 vs. 7.61±2.03), had a lower pain level (4.81±2.22 vs. 8.24±2.39), and the possibility of air leakage as a postoperative complication (41% vs. 56%) was lower than in the case patients who have undergone open thoracotomy. Conclusions. It can be concluded that choosing the VATS method instead of the open thoracotomy can reduce postoperative complications (such as length of hospital stay, pain level and possibility of air leakage) and can reduce the costs of treatment and the degree of health system use, especially during Covid-19 pandemic.