Day Case Local Anaesthetic Thoracoscopy: Experience from 2 District General Hospitals in the United Kingdom.

BACKGROUND: Local anaesthetic thoracoscopy (LAT) can be a vital procedure for diagnosis of unexplained pleural effusions. Traditionally, poudrage for pleurodesis and insertion of a large bore drain necessitated admission. There has been a shift towards performing LAT as a day case procedure with indwelling pleural catheter (IPC) insertion. This was advocated during the COVID pandemic by the British Thoracic Society (BTS). To determine the feasibility of such pathways, continuous evaluations are required. METHODS: All day case LAT procedures with IPC insertion, performed in theatre, were identified at two large district general hospitals (Northumbria HealthCare in the North East of England and Victoria Hospital, NHS Fife, in Scotland). Rapid pleurodesis with talc was not performed due to local staffing problems. All patients had their LAT in theatre under conscious sedation with a rigid scope. Demographics, clinical, radiological and histopathological characteristics and outcomes were collected. RESULTS: 79 patients underwent day case LAT. The lung did not deflate, meaning biopsies were not enabled, in four of the patients. The mean age was 72 years (standard deviation 13). Fifty-five patients were male and twenty-four were female. The main diagnoses were lung cancers, mesotheliomas and fibrinous pleuritis with an overall diagnostic sensitivity of 93%. Other diagnoses were breast, tonsillar, unknown primary cancers and lymphomas. Seventy-three IPCs were simultaneously placed and, due to normal macroscopic appearances in two patients, two large bore drains were placed and removed within one hour of LAT termination. Sixty-six (88%) patients were discharged on the same day. Seven patients required admission: one for treatment of surgical emphysema, four because they lived alone, one for pain control and one for control of a cardiac arrythmia. Within 30 days, there were five IPC site infections with two resultant empyemas (9%), with no associated mortality. Two patients developed pneumonia requiring admission and one patient required admission for pain management. The median number of days for which the IPCs remained in situ was 78.5 days (IQR 95). The median length of stay (LoS) was 0 days (IQR 0). No patients required further interventions for pleural fluid management. 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. The health economics of preventing admission are considerable, as our previous analysis showed a median length of stay of 3.96 days, although we are not comparing matched cohorts.

Malignus pleuralis effusiókkal küzdo betegek ellátása egy regionális onkológiai központban a COVID-19-pandémia idoszakában.

INTRODUCTION: Malignant pleural effusion is a complication of tumors heralding poor outcome. It may be life-threatening, so advanced cases should be treated as an oncological emergency. OBJECTIVE: We aimed to provide complex care to patients with malignant pleural effusion during the COVID-19 pandemic at the University of Pécs Medical School, in the Department of Oncotherapy. During the pandemic, we introduced the thoracocentesis as a routine method in our department without previous experiences. METHOD: Results of diagnosing and treating pleural effusion of patients between March 18th of 2020 and May 31st of 2021 were summarized. RESULTS: We have analyzed data of 45 patients, two-thirds (66.7%) of them were women, the median age was 67 years. 57.8% of patients received systemic anticancer therapy during the study. The total number of thoracocentesis was over 120, one-third of the patients required more than five interventions. Only three iatrogenic pneumothorax cases were detected, no other serious complications were experienced. The procedures - that were aimed to mitigate symptoms in most cases (80%) - were considered successful. However, 48.9% of the patients were no longer alive at the end of the study period indicating very poor prognosis of pleural carcinosis. DISCUSSION AND CONCLUSION: Clinical care of oncological patients was continuous during the pandemic; patients treated as part of emergency care were often seen in advanced disease state. Treatment of malignant pleural effusion requires oncological foresight as well as implementing an invasive approach. Our study has shown that discussion of the topic is relevant, may reveal difficulties and need for improvement. Our results are consistent with literature data, we have experienced less complications than reported in the literature. Orv Hetil. 2022; 163(26): 1015-1022.