P207 Daycase medical thoracoscopy and pleurodesis: outcomes and cost effectiveness

Aim To assess the feasibility and safety of talc pleurodesis performed as part of daycase medical thoracoscopy. Methods Conventionally, medical thoracoscopy with talc pleurodesis involves inpatient stay. In our institution this happens as a daycase procedure with patients admitted on the day of procedure. We use a Richard Wolf®5 mm mini thoracoscope through a 5.5 mm port. At the end of the procedure eligible cases have talc poudrage, followed by insertion of indwelling pleural catheter (IPC) through the same port instead of a surgical drain. The IPC is then attached to an underwater seal and suction applied for 4 hours before the drain is capped off and the patient discharged. District nurses are asked to drain the IPC daily for the first 5 days. Once the drain output is Results Between April 2019 and June 2020, 42 patients underwent thoracoscopy of which 40 patients underwent day case thoracoscopy with pleurodesis. However, 2/40 patients required a short duration unplanned admission. All patients were followed up for 70 days. One patient in conventional thoracoscopy group required surgical intervention for pleural infection. There were 4 deaths in the day case cohort compared to 9 deaths in the conventional thoracoscopy cohort within 70 days. Median time to removal of IPC was 14 days and IPC was successfully removed in 35 patients by the end of 70 days. Three patients had continuing drainage at day 70, one patient died with drain in situ and another chose to leave the drain in situ despite cessation of drainage. Overall rate of successful cessation of drainage was 90% (36/40). An initial estimated cost-analysis showed the procedure to be largely cost neutral for the local healthcare economy. Conclusion This study suggests that thoracoscopy and talc poudrage can be performed safely as a day case procedure. Further data is needed for longterm outcomes and cost effectiveness.