The safety of medical thoracoscopy in a group at high risk for complications

Our plain-English summary of The safety of medical thoracoscopy in a group at high risk for complications, by M. Metintas, G. Ak, H. Yildirim, et al (Journal of Bronchology & Interventional Pulmonology, 2013).

The study

• Authors: M. Metintas, G. Ak, H. Yildirim, S. Danacioglu, E. Dundar, S. Metintas
• Journal: Journal of Bronchology & Interventional Pulmonology
• Published: 2013;20(3):224-31
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: The use of medical thoracoscopy (MT) for the diagnosis and/or palliative treatment of pleural effusions is expected to become more widespread in the coming years. The aims of the present study were to establish the safety of MT in a group of patients at high risk for complications and to determine the factors that affect the development of complications.

Methods: A total of 355 patients who underwent MT were divided into 2 groups: patients at high risk for complications and patients who had no risk factor. After the procedure, the complications of MT were recorded. All patients were followed up for at least 24 months. To evaluate the relationship between variables and complications, logistic regression models were applied.

Results: Of the 355 patients, 106 had one or more risk factors, whereas 249 did not have any risk factor. Pain (12.3%) was the most frequent complication in the high-risk patients, and subcutaneous emphysema (10.3%) was the most frequently reported complication in the normal-risk patients. Only pain was observed more frequently in the high-risk patients compared with the normal-risk patients. Talc pleurodesis was associated with prolonged air leak (8.3%) and empyema (5%). The percentage of patients with no complication was 58.6%. The mortality rate was 0.28%. In the multivariate analysis, the presence of mesothelioma was identified as a factor that increased the risk of complication.

Conclusions: MT is a safe method for the diagnosis of patients with pleural effusion, even in patients at high risk for complications. However, complications, found in approximately half of the patients, should also be examined in terms of cost.

In plain English

This study, from a university chest diseases department in Eskisehir, Turkey, examined the safety of medical thoracoscopy (a scope passed into the chest to view and biopsy the pleura) in 355 adults with an exudative pleural effusion that earlier examinations had not diagnosed, seen between January 2002 and January 2009. Before the procedure, 106 patients were classed as high-risk for complications, for reasons such as advanced age or heart failure, and 249 as normal-risk. Final diagnoses included mesothelioma in 120 patients and benign asbestos pleurisy in 45. Pain was the only complication statistically significantly more common in high-risk patients (12.3%) than in normal-risk patients (4.4%). Overall, 58.6% had no complication and one patient died (0.28%). Talc pleurodesis was associated with more prolonged air leak and empyema. Tumor growth at the entry site occurred in 23 of 216 patients with malignant disease. After adjustment, mesothelioma was associated with late complications. The authors concluded the procedure was safe even in high-risk patients when done by experienced physicians in high-volume centers, but noted that complications could add to cost.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Single-center study of consecutive patients recorded in a prospectively maintained pleural disease database, comparing complications in high-risk and normal-risk patients, with univariate and multivariable logistic regression analysis
• Who was studied: 355 adults (209 men, 146 women) with exudative pleural effusion that had no specific diagnosis after cytologic, microbiological or clinical examination. They underwent medical thoracoscopy at the Chest Diseases Department, Eskisehir Osmangazi University Medical Faculty, Turkey, from January 2002 to January 2009, and were followed for at least 24 months.
• Exposure: Medical thoracoscopy with a rigid thoracoscope under mild sedation and local anesthesia. Talc pleurodesis (5 g sterile dry talc, by insufflation or slurry) was performed in 181 patients. The article does not study asbestos exposure or fiber types.
• Main results:
  • Of the 355 patients, 106 (29.9%) had one or more risk factors and were classed as high-risk. The other 249 (70.1%) had none and were classed as normal-risk.
  • Mesothelioma was diagnosed in 120 of 355 patients (33.8%): 24 of 106 high-risk patients (22.6%) and 96 of 249 normal-risk patients (38.6%).
  • Benign asbestos pleurisy was diagnosed in 45 of 355 patients (12.7%): 11 high-risk (10.4%) and 34 normal-risk (13.7%); P = 0.396.
  • Pain was the only complication statistically significantly more frequent in high-risk patients: 12.3% (13 of 106) vs 4.4% (11 of 249) in normal-risk patients; P = 0.007. Some other complications were numerically more frequent in high-risk patients without reaching significance, for example transient hypotension (6.6% vs 2.4%; P = 0.066).
  • Subcutaneous emphysema was the most common complication in normal-risk patients (10.3%).
  • Patients who had talc pleurodesis (n = 181), compared with those who did not (n = 174), had more prolonged air leak over 5 days (8.3% vs 2.3%; P = 0.013) and more empyema (5.0% vs 0.6%; P = 0.020).
  • Local tumoral invasion through the entry site was the most frequent complication among patients with malignant pleural diseases: 23 of 216 (10.6%).
  • In multivariable analysis, mesothelioma was independently associated with late complications (adjusted value 4.41, range 1.93 to 10.07). Talc pleurodesis was associated with late complications in unadjusted analysis (3.32, 1.45 to 7.59), but this was no longer significant after adjustment (1.34, 0.56 to 3.22).
  • 208 of 355 patients (58.6%) had no complication: 148 of 249 normal-risk (59.4%) and 60 of 106 high-risk (56.6%). The difference was not significant (P = 0.650).
  • One normal-risk patient with extensive subcutaneous and mediastinal emphysema died 8 days after thoracoscopy, a mortality rate of 0.28% (1 of 355).
• The authors' conclusion: The authors concluded that medical thoracoscopy under local anesthesia and mild sedation is a safe and effective diagnostic method for pleural effusion, even in patients at high risk for complications, when performed by experienced physicians in high-volume centers. They added that complications, even minor ones, may increase cost and should be considered in future studies.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening, Talc and vermiculite.

Medical terms in this study, explained in our Lexicon: Medical Thoracoscopy, Palliative Care, Pleural Effusion, Emphysema, Talc Pleurodesis, Empyema, Multivariate Analysis, Mesothelioma.

Related studies

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• Medical thoracoscopy, results and complications in 146 patients: a retrospective study — M. Hansen, P. Faurschou, et al. (1998)
• Outcomes and complications following medical thoracoscopy — F.J. Brims, M. Arif, et al. (2012)
• Feasibility and safety of outpatient medical thoracoscopy at a large tertiary medical center: a collaborative medical-surgical initiative — Z.S. DePew, D. Wigle, et al. (2014)
• Outcome of patients diagnosed with fibrinous pleuritis after medical thoracoscopy — M. Metintas, G. Ak, et al. (2012)
• Diagnostic accuracy and safety of semirigid thoracoscopy in exudative pleural effusions in Denmark — F. Willendrup, U. Bodtger, et al. (2014)

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