P99 Day case thoracoscopy with IPC insertion- experience from 2 district general hospitals. (11th November 2022)

• Record Type: Journal Article
• Authors: Turner, M; Craighead, F; Mackenzie, J; Aujayeb, A
• Is Part Of: Thorax. Volume 77(2022)Supplement 1
• Page Start: A134
• Page End: A135
• Publication Date: 2022-11-11
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thorax-2022-BTSabstracts.235
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Background: Local anaesthetic thoracoscopy (LAT) used to diagnose unexplained pleural effusions usually involves poudrage for pleurodesis and insertion of a large bore drain with admission. There has been a shift towards performing LAT as a day case procedure with indwelling pleural catheter (IPC) insertion. We sought to determine the feasibility of such a pathway. Methods: All day case LAT procedures with IPC insertion were identified at 2 district general hospitals (Northumbria HealthCare in the North East of England and Victoria Hospital, NHS Fyfe in Scotland). Rapid pleurodesis with talc is not performed. All patients have their LAT in theatre under conscious sedation with a rigid scope. Demographics, clinical and histopathological characteristics were collected. Results: 75 patients underwent day case LAT. The lung did not deflate, not enabling biopsies in 4. The mean age was 72 years (range 34–83). 51 were male and 24 were female. The main diagnoses were 20 lung cancers, 16 mesotheliomas and 28 fibrinous pleuritis (4 underwent VATS and were diagnosed with VATS, 1 was labelled as radiological lung cancer)- overall diagnostic sensitivity was 95%. Other diagnoses were breast, tonsillar, unknown primary cancers and lymphomas. Of the 71 patients who underwent LAT, 65 IPCs were simultaneously placed and due to normal macroscopic appearances in 2 patients, 2 large bore drains were placed and removed within an hour of LAT termination. 67 (89%) patients were discharged on the same day. 7 required admission; 2 for treatment of surgical emphysema, 4 as lived alone, 1 for pain control and 1 for control of a cardiac arrythmia. 10 (13%) developed surgical emphysema post-op, 3 of those required further drains. Within 30 days, there were 5 IPC site infections with 2 resultant empyemas (9%)- there was no associated mortality with that, 2 patients developed pneumonia requiring admission and 1 patient required admission for pain management. Median number of days the IPCs remained in situ was 78.5 days (IQR 95). Conclusions: Day case LAT with IPC insertion is feasible with this current set up, with a median stay of 0 days and should be widely adopted. Complication rates are The health economics of preventing admission are considerable as our previous analysis showed a median length of stay of 3.96 days (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7823154/ ), although we are not comparing matched cohorts.