Day case local anaesthetic thoracoscopy - a review of service

Abstract

Background: Northumbria Healthcare NHS Foundation Trust runs a large pleural service. Local anaesthetic thoracoscopy (LAT) is a well-established procedure in undiagnosed pleural effusions, performed in theatre under conscious sedation. Patients were traditionally admitted for a mean of 3.4 days and had a large bore drain inserted post LAT with pleurodesis. The Covid-19 pandemic has forced day case LAT provision and IPC placement without pleurodesis to minimise infection risk. We describe our experience.

Methods: Notes of patients requiring day case LAT between July-Dec 2020 were analysed. Basic demographics and outcomes were collected. A descriptive analysis of the data was performed.

Results: 14 patients underwent day case LAT. All had negative pre-op Covid-19 swabs: mean age 70.4 years (range 24-82), 11 male, 3 female. Diagnoses included 5 lung cancers, 4 mesotheliomas and 3 fibrinous pleuritis. The lung did not deflate, not enabling biopsies in 2. Non-malignant diagnoses are presumed. 11 IPCs and 1 large bore drain were inserted due to 1 immediate complication (surgical emphysema). 1 patient developed an empyema within 30 days. 7 of 11 IPCs have already been removed due to pleurodesis occurring (mean number days 27.5, range 16-72). All were discharged the same day except the one requiring a large bore drain who stayed overnight.

Conclusions: We have thus transformed our service after more than a decade of providing LAT as an inpatient service. This is a small cohort of patients but proves the feasibility and safety of day case LAT with massive reduction in inpatient stay. The Covid-19 pandemic has transformed our service for the better. Further qualitative work should elucidate the acceptability of such a pathway for patients.