Outpatient Thoracoscopic Mediastinal Biopsy: A Safe and Cost-Effective Approach

• Published in: The Annals of thoracic surgery Vol. 110; no. 5; pp. 1726 - 1729
• Main Authors: Brownlee, Andrew R., Mitzman, Brian, Cyzman, Ryan, Ferguson, Mark K.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.11.2020
• Subjects: Adult; Aged; Aged, 80 and over; Biopsy - adverse effects; Biopsy - economics; Cost-Benefit Analysis; Frozen Sections; Humans; Mediastinum - pathology; Middle Aged; Outpatients; Retrospective Studies; Thoracic Surgery, Video-Assisted - methods
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2020.04.056

Most mediastinal biopsy patients are managed with an overnight inpatient stay and chest drainage. We sought to determine the safety, accuracy, and cost of outpatient thoracoscopic mediastinal biopsy by reviewing operative techniques, perioperative outcomes, and admission charges for this procedure. This single-institution retrospective study reviewed all patients who underwent elective thoracoscopic mediastinal biopsy between 2012 and 2017. Patients were assigned to outpatient or inpatient management preoperatively based on surgeon judgment and preference. The procedures were performed in the supine or lateral decubitus position using ports only. Patients discharged on postoperative day 0 (outpatient) were compared with those discharged on postoperative day 1 or greater (inpatient). A total of 46 patients were included. Thirty-one patients were outpatients, and 15 were admitted. The outpatient cohort was younger than the inpatient group (48 years of age vs 66 years of age; P = .001). There was no statistically significant difference in other baseline characteristics. The operative time was longer (P = .001) and the total charges were higher (P = .003) in the inpatient cohort. One patient in each group had a nondiagnostic procedure. One patient in the outpatient group returned to the emergency department for pain but was discharged. There were no complications. Outpatient thoracoscopic mediastinal biopsy is a safe and effective procedure that has lower charges compared with inpatient management and should be considered for patients undergoing this procedure.