0
Correspondence |

Provision of Day-Case Local Anesthetic Thoracoscopy: A Multicenter Review of Practice FREE TO VIEW

Ioannis Psallidas, PhD; John P. Corcoran, BMBCh; Janet Fallon, MBBS; Oliver Bintcliffe, MBCHb; Pasupathy Sivasothy, PhD; Nick Maskell, DM; Fabien Maldonado, MD, FCCP; Justin Pepperell, MD; Najib M. Rahman, DPhil
Author and Funding Information

Editor's Note: Authors are invited to respond to Correspondence that cites their previously published work. Those responses appear after the related letter. In cases where there is no response, the author of the original article declined to respond or did not reply to our invitation.

FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST the following: I. P. is the recipient of a REPSIRE2 European Respiratory Society Fellowship [RESPIRE2–2015–7160]. N. M. R. is funded by the National Institute Health Research (NIHR) Oxford Biomedical Research Centre. None declared (J. P. C., J. F., O. B., P. S., N. M., F. M., J. P.).

aOxford Centre for Respiratory Medicine and Oxford Respiratory Trials, Oxford, England

bMusgrove Park Hospital, Taunton, England

cAcademic Respiratory Unit, University of Bristol, Bristol, England

dDepartment of Medicine, Cambridge University Hospital NHS Trust, Cambridge, England

eDivision of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine and Mayo Clinic, Nashville, TN

CORRESPONDENCE TO: Ioannis Psallidas, PhD, Oxford University NHS Foundation Trust, Old Road, Churchill site, OX3 7LE, Oxford, UK


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


Chest. 2017;151(2):511-512. doi:10.1016/j.chest.2016.11.002
Text Size: A A A
Published online

Pleural disease is a common health problem and is estimated to affect > 3,000 people per million population. Pleural effusion is the most common condition in this group, and in approximately 75% of cases, the clinical history, physical examination, radiographic techniques, and pleural fluid analysis will identify a cause for the pleural effusion, with the remaining 25% requiring further invasive diagnostic procedures.

An increasing trend has been seen in the number of centers performing local anesthetic thoracoscopy (LAT) as a gold standard diagnostic and therapeutic procedure. There is previous evidence from a single site that the technique can be performed on a day-case basis without compromising its efficacy and safety. This is the first multicenter study assessing LAT as a day-case procedure and includes data from four centers in the United Kingdom and one center in the United States. The primary aim of this paper was to report data on safety, feasibility, and outcomes of day-case LAT.

This is a retrospective review of prospectively collected data conducted in five centers from January 1, 2010 until January 1, 2015; patients who were investigated with LAT were included. Each center initiated the use of day-case LAT at different time points within the study period, and therefore data were collected across a range of periods for each individual site. All procedures were performed in either a procedure suite or an operating theatre using standard techniques.

A total of 521 procedures were performed across the five centers (Table 1). Nineteen procedures (3.6%) were excluded from the analysis due to missing data. A day-case procedure was undertaken in 242 of 502 patients (48.2%) during the study period (Fig 1), with the remainder admitted to the hospital following thoracoscopy. In 40 of 242 patients (16.5%), LAT was abandoned before or during the procedure, with the most common causes demonstrated in Figure 1. In 17 of 40 cases in which LAT was not possible, the procedure was converted to ultrasonographically guided pleural biopsy on the operating table, with establishment of the underlying diagnosis in 15 of 17 of these cases (88.2%).

Table Graphic Jump Location
Table 1 Patient Characteristics and Procedure Details for Day-Case Local Anesthetic Thoracoscopy Cohort

Figure Jump LinkFigure 1 Day-case local anesthetic thoracoscopy procedures conducted during the study period. LAT = local anesthetic thoracoscopy; TB = tuberculosis.Grahic Jump Location

Of all patients undergoing day-case thoracoscopy, an underlying diagnosis was established in 196 of 202 patients (97%) (Fig 1). The vast majority (238 of 242) of day-case LAT procedures (98.3%) were performed without complications. Two cases were complicated by vasovagal reactions during or following the procedure, one case was complicated by late pleural infection resulting in readmission, and in one case, the patient experienced significant pain after the procedure and required opioid analgesia to achieve symptom control.

Results are associated with the observation that in selected patients, LAT can be performed safely as a day-case procedure in a variety of centers with different characteristics, including size, population, and means of health-care service provision, models without compromising patient safety.

The overall excellent diagnostic yield of the procedure (97%) suggests that LAT could be performed earlier in the diagnostic pathway, and in selected patients LAT could potentially be used as the first and only test needed to obtain a definitive diagnosis.

In summary, our data set suggests that day-case LAT can be integrated successfully into pleural service provision across a range of health-care settings. This can offer a more convenient alternative to the traditional inpatient approach while maintaining an excellent diagnostic yield and safety profile.

References

Hooper C. .Lee Y.C. .Maskell N. . Pleural Guideline Groupet al Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65:ii4-ii17 [PubMed]journal. [PubMed]
 
Colins Tr  .Sahn S.A. . Thoracocentesis, clinical value, complications, technical problems and patient experience. Chest. 1987;91:817-822 [PubMed]journal. [CrossRef] [PubMed]
 
Bhatnagar R. .Corcoran J.P. .Maldonado F. .et al Advanced medical interventions in pleural disease. Eur Respir Rev. 2016;25:199-213 [PubMed]journal. [CrossRef] [PubMed]
 
Depew Z.S. .Wigle D. .Mullon J.J. .et al Feasibility and safety of outpatient medical thoracoscopy at a large tertiary medical center: a collaborative medical-surgical initiative. Chest. 2014;146:398-405 [PubMed]journal. [CrossRef] [PubMed]
 
Rahman N.M. .Ali N.J. .Brown G. . British Thoracic Society Pleural Disease Guideline Groupet al Local anesthetic thoracoscopy: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65:ii54-ii60 [PubMed]journal. [PubMed]
 

Figures

Figure Jump LinkFigure 1 Day-case local anesthetic thoracoscopy procedures conducted during the study period. LAT = local anesthetic thoracoscopy; TB = tuberculosis.Grahic Jump Location

Tables

Table Graphic Jump Location
Table 1 Patient Characteristics and Procedure Details for Day-Case Local Anesthetic Thoracoscopy Cohort

References

Hooper C. .Lee Y.C. .Maskell N. . Pleural Guideline Groupet al Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65:ii4-ii17 [PubMed]journal. [PubMed]
 
Colins Tr  .Sahn S.A. . Thoracocentesis, clinical value, complications, technical problems and patient experience. Chest. 1987;91:817-822 [PubMed]journal. [CrossRef] [PubMed]
 
Bhatnagar R. .Corcoran J.P. .Maldonado F. .et al Advanced medical interventions in pleural disease. Eur Respir Rev. 2016;25:199-213 [PubMed]journal. [CrossRef] [PubMed]
 
Depew Z.S. .Wigle D. .Mullon J.J. .et al Feasibility and safety of outpatient medical thoracoscopy at a large tertiary medical center: a collaborative medical-surgical initiative. Chest. 2014;146:398-405 [PubMed]journal. [CrossRef] [PubMed]
 
Rahman N.M. .Ali N.J. .Brown G. . British Thoracic Society Pleural Disease Guideline Groupet al Local anesthetic thoracoscopy: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65:ii54-ii60 [PubMed]journal. [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543