Our aim was to determine the impact of medical thoracoscopy (MT) on diagnostic work-up of patients with pleural effusions (PE) presenting to Respiratory Medicine by comparing number of investigations required to arrive at diagnosis, median time to diagnosis, length of hospital stay, need for other surgical interventions, and patient outcome before and after introduction of MT. MT began at our institution in 2004.
Two year periods were selected: 2000–2001 (pre-MT) and 2005–2006 (post-MT). Retrospective review of all case notes of patients with PE ICD codes was performed. Data were entered into spreadsheet and analyzed using SPSS. Values were expressed as percentages, medians (interquartile ranges), and comparisons between groups were performed with Chi-square test. p<0.05 was considered signficant.
192 patients’ case notes were reviewed. 31 patients were excluded as MT was performed for talc poudrage in 29 malignant PE and incomplete follow up data in 2 patients. 107 patients with PE before MT and 54 patients after MT were analyzed. The median age of two groups were 67 and 58 years respectively (p=0.26). After introduction of MT, median number of investigations required to arrive at diagnosis decreased from 4 to 2 (p=0.015), length of hospital stay from 11 days to 5 days (p<0.01), and time to diagnosis from 19 days to 5 days (p<0.01). MT has also led to a marked decrease in referrals for video-assisted thoracic surgery and open thoracotomy from 19% to 0%, bronchoscopy from 18% to 7%; and transthoracic needle aspiration from 5% to 0%. Malignancy was diagnosed in 9% of patients with indeterminate PE in the pre-MT period who refused surgery.
MT has a significant impact on the diagnostic pathway of a patient with PE.
Incorporating MT has expedited work-up by decreasing time to diagnosis, number of investigations to achieve diagnosis, and shorter hospital stay. MT has obviated need for major surgery, and is conceivable that early MT can lead to potential cost-savings.
Pyng Lee, No Financial Disclosure Information; No Product/Research Disclosure Information