title: Outcomes and complications following medical thoracoscopy.
abstract: BACKGROUND
  Thoracoscopy is an invasive procedure that may be performed by physicians for the investigation of exudative pleural effusion using local anaesthesia, conscious sedation and a rigid thoracoscope.
  
  
  OBJECTIVE
  We sought to evaluate the safety and outcome of thoracoscopy in Portsmouth Hospitals, UK, a dockyard city with high previous asbestos usage.
  
  
  METHODS
  Retrospective casenote, radiology and laboratory result analysis of patients undergoing thoracoscopy in our institution over a 12-month period.
  
  
  RESULTS
  Fifty-seven of 58 casenotes were available for analysis. Median (interquartile range) age was 73.0 (66.5-79.0) years and 44 (77.2%) were male. Median time with chest drain post-procedure was 3.0 (2.0-5.0) days, and length of stay (LOS) was 4.0 (2.0-8.0) days. Malignant histology was reported in 40 (70.2%), with 25 (62.5%) cases of mesothelioma. There were no deaths related to the procedure. Hospital-acquired infection (HAI) occurred in six (10.5%: pneumonia four, empyema two), all had malignancy. The presence of HAI significantly prolonged the LOS 9.0 (7.5-23.5) vs no HAI 4.0 (2.0-7.0) days; P = 0.006). Four patients died within 1 month of the procedure, three had a malignant diagnosis, all had suffered HAI. Trapped lung (persistent hydropneumothorax 5 days post-procedure) occurred in 11 (19.2%), six of whom had benign histology. Performance status (European Cooperative Oncology Group) prior did not differ with reported histological type: benign 2.0 (2.0-2.0), malignant 2.0 (2.0-3.0), P = 0.170.
  
  
  CONCLUSIONS
  Serious complications following thoracoscopy are rare. HAI is associated with malignancy and prolonged hospital stay. Benign histology may still confer significant morbidity.
authors.affiliation: Department of Thoracic Medicine, University College London Hospital NHS Foundation Trust, London, UK. f.brims@ucl.ac.uk
authors.forename: Fraser John Hall
authors.initials: FJ
authors.lastname: Brims
authors.forename: Mohammad
authors.initials: M
authors.lastname: Arif
authors.forename: Anoop Jivan
authors.initials: AJ
authors.lastname: Chauhan
mesh_terms: D000368:Aged; D001195:Asbestosis / Q000453:epidemiology / Q000601:surgery*; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology / Q000601:surgery; D018288:Carcinoma, Small Cell / Q000453:epidemiology / Q000601:surgery; D015505:Chest Tubes / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008175:Lung Neoplasms / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008654:Mesothelioma / Q000453:epidemiology / Q000601:surgery; D009017:Morbidity; D010996:Pleural Effusion / Q000453:epidemiology / Q000601:surgery*; D016066:Pleural Effusion, Malignant / Q000453:epidemiology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D020708:Thoracoscopes; D013906:Thoracoscopy / Q000009:adverse effects* / Q000295:instrumentation / Q000706:statistics & numerical data; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology