Procedures: Interventional Pulmonary Procedural Safety and Outcomes |

The Safety of Medical Thoracoscopy in a Community Based Interventional Pulmonology Fellowship Program FREE TO VIEW

John Egan, MD; Benjamin Seides, MD; Sara Greenhill, MD; Elsa Garza, ACNP; Amit Goyal, MD; Kevin Kovitz, MD; Neeraj Desai, MD
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Chicago Chest Center, Elk Grove Village, IL

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):999A. doi:10.1016/j.chest.2016.08.1105
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SESSION TITLE: Interventional Pulmonary Procedural Safety and Outcomes

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 26, 2016 at 02:45 PM - 04:15 PM

PURPOSE: To determine the safety of medical thoracoscopy (MT) in a community based interventional pulmonology fellowship program.

METHODS: We performed an observational cohort study including all MT procedures performed by our program in three community hospitals. Patients were referred to the Interventional Pulmonology (IP) service for evaluation of recurrent exudative pleural effusion or for palliation of known or suspected malignant pleural effusion. Procedures were performed by an attending interventional pulmonologist. An IP fellow participated in most cases. The majority of MT cases were performed with ultrasound guidance and used a Wolf rigid thoracoscopy set (Richard Wolf, Vernon Hills, IL). All MT were performed under monitored anesthesia care in the operating room. Primary endpoints included major complications directly related to the MT such as clinically significant bleeding, infection, pneumothorax, respiratory failure, and any procedure related mortalities.

RESULTS: 193 MT were performed on 185 patients between January 2007 and March 2016. Ten cases were excluded as there was no procedural data available. Of the remaining 183 cases there were 107 men and 76 women with mean age 67.6 ± 13.8 years. Parietal pleural biopsies were performed in 155 of the 183 procedures to investigate the etiology of recurrent exudative pleural effusion and their diagnostic yield was 98%. The most common results were pleuritic and chronic inflammation (42%), followed by mesothelioma (13%), lung cancer (12%), and breast cancer (11%). There were 119 palliative procedures performed during MT. Of these, 66% (79/119) received a tunneled pleural catheter. The remaining 34% (40/119) were found at the time of MT to have a fully expandable lung or a partially trapped lung. These patients underwent talc poudrage (TP) and data was availble in 37 of the 40 cases. The overall proportion of successful TP was 78% (29/37) and this proportion increased when considering patients who had no evidence of partially trapped lung at the time of thoracoscopy to 87% (26/30). The major adverse event (MAE) rate was 2.1% (4/183). MAE included 2 cases of pneumomediastium and subcutaneous emphysema requiring either placement of a new chest tube or connecting tunneled pleural catheter to in-line suction. There was one case of hemorrhage requiring open thoracotomy and one case of respiratory failure requiring intubation. There were no deaths associated with the procedure.

CONCLUSIONS: Our analysis confirms the safety of the procedure with an adverse event rate of 2.1% and no deaths, consistent with published safety data for MT. To our knowledge, this is the first community based IP safety analysis of MT.

CLINICAL IMPLICATIONS: Medical thoracoscopy can be performed safely in a community based setting with high diagnostic and palliative outcomes.

DISCLOSURE: The following authors have nothing to disclose: John Egan, Benjamin Seides, Sara Greenhill, Elsa Garza, Amit Goyal, Kevin Kovitz, Neeraj Desai

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