Abstract
Introduction: Video Assisted Thoracoscopic Surgical (VATS) pleural biopsies are part of the algorithm to investigate unilateral pleural effusions. Visceral pleural thickening can cause trapped lung, and indwelling pleural catheter (IPC) placement is standard management. The risk of developing surgical emphysema is unknown.
Aim: To establish the incidence, severity, impact and risk factors for surgical emphysema post VATS pleural biopsy and IPC placement (VATS-IPC).
Method: We retrospectively analysed consecutive patients undergoing VATS-IPC. Chest radiographs and electronic discharge summaries were reviewed. Surgical emphysema was radiographically graded as: 1 localised to IPC site; 2 ipsilateral chest wall; 3 involvement of neck; 4 involvement of contralateral chest wall.
Results: Between 2000 and 2018, 176 cases were identified. The median age was 70 [interquartile (IQR) range 64-76] years and 126/176 (72%) were male. Surgical emphysema was identified in 97/176 (55%) cases with grade 4 present in 16/176 (9%).
In patients with grade ≥2 a malignant diagnosis was more likely (97% versus 83%; p=0.01; OR 5.28(95%CI 1-26). No difference in age or gender was identified across the grades (p=0.47 & p=0.35 respectively). Length of stay (LOS) increased across the grades of severity (p<0.01). In those with Grade 4 disease, the LOS was 12.9[8-18.25]days versus 4[3-7] days in those without surgical emphysema (p<0.01). Grading remained significantly associated with LOS when adjusted for diagnosis, age and gender (p=0.03).
Conclusion: Severe emphysema occurred in nearly 1 in 10 patients. Severity was associated with a malignant diagnosis and with a significant increase in LOS. Further investigation is warranted to identify other risk factors.
Footnotes
Cite this article as: European Respiratory Journal 2019; 54: Suppl. 63, PA1079.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2019