The Role of Day-case Thoracoscopy at a District General Hospital: A Real World Observational Study

Overview

Journal Future Healthc J

Specialty Health Services

Date 2024 Aug 30

PMID 39211935

Authors

Sidra Kiran

Akash Mavilakandy

Sarah Rahim

Muhammed Naeem

Samantha Rawson

Darren Reed

Georgios Tsaknis

Raja V Reddy

Affiliations

Soon will be listed here.

Abstract

Objective: To assess the feasibility and safety of talc pleurodesis performed as part of day-case medical thoracoscopy.

Methods: A Richard Wolf® 5 mm mini thoracoscope through a 5.5 mm port was used with eligible cases having talc poudrage followed by insertion of indwelling pleural catheter (IPC). District nurses drain the IPC daily for the first 5 days. Once the drain output is <150 mL, the frequency is progressively reduced to once weekly. The drain is removed after two consecutive dry taps 1 week apart.

Results: Overall, 51 patients underwent day-case thoracoscopy. Median time to removal of IPC for our day-case protocol was 14 days. There were seven deaths within 70 days among 41 patients with malignant pleural effusion in the day-case cohort, compared to eight deaths in the 33 conventional thoracoscopy controls. Overall, the day-case cohort observed a statistically significant reduction in all-cause mortality at 180 days compared to the conventional cohort (log rank 0.024). The average cost per patient of the day-case and inpatient cohort was £1,328.0 ± 106.0 and £1,835.0 ± 295.0 ( 0.961).

Conclusion: This study suggests that thoracoscopy and talc poudrage can be performed safely as a day-case procedure. Further data are needed to ascertain long-term outcomes.

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