The role of day-case thoracoscopy at a district general hospital: A real world observational study

• Published in: Future healthcare journal Vol. 11; no. 3; p. 100158
• Main Authors: Kiran, Sidra, Mavilakandy, Akash, Rahim, Sarah, Naeem, Muhammed, Rawson, Samantha, Reed, Darren, Tsaknis, Georgios, Reddy, Raja V.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.09.2024; Royal College of Physicians
• Subjects: Day-case; Indwelling pleural catheter; IPC; Local anaesthetic thoracoscopy; Medical thoracoscopy; Talc pleurodesis; Talc poudrage; Talc pleurodesis; Indwelling pleural catheter; Talc poudrage; Medical thoracoscopy; IPC; Local anaesthetic thoracoscopy; Day-case
• ISSN: 2514-6645; 2514-6653
• DOI: 10.1016/j.fhj.2024.100158

To assess the feasibility and safety of talc pleurodesis performed as part of day-case medical thoracoscopy. 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. 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 p = 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 (p = 0.961). 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.