P78 Impact of COVID19 pandemic on Thoracoscopy services – change in practice to day-case procedure

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Background Thoracoscopy under local anaesthesia (LAT) is a well-established diagnostic tool to evaluate patients with suspected malignant pleural effusion. Most centres in the UK admit patients post procedure for overnight monitoring and discharge home the next day. During first wave of COVID19 pandemic, elective procedures in particular aerosol generating were put on hold to mitigate risk of infection. Organising a bed for inpatient elective procedures also proved challenging. Aim To assess outcomes in patients who were discharged same day post Thoracoscopy – diagnostic accuracy, complications and readmission within 30 days. The data was compared to the preceding year to evaluate the impact of change in practice. Methods Retrospective review of consecutive LAT procedures in patients with suspected malignant pleural effusions between June 2020 – May 2022 (24 months) Service was put on hold between March and June 2020. Results Fifty-eight patients underwent LAT between June 2020 and May 2022. Mean age 76 years. Thirty-five patients diagnosed with malignancy – 22 mesothelioma, 11 metastatic adenocarcinoma, one clear cell carcinoma and one non small cell with squamous differentiation. 3 false negative pleural biopsies: 2 confirmed mesothelioma on Video assisted thoracoscopic surgery (VATS) and the other was lymphoma on axillary lymph node biopsy. 23 biopsies were negative for malignancy; 2 confirmed negative on VATS and the remaining confirmed benign by close monitoring. They included infection and organ failure. Overall diagnostic accuracy was 96.5%. 55 (95%) patients were discharged the same day. 40 (69%) of the patients had Indwelling pleural catheter (IPC) implanted. Of the 95% of the patients only two patients were readmitted within 30 days post procedure due to procedure related chest pain and surgical emphysema. Of the 3 (5%) admissions post procedure, only 1 had air leak; one was generally unwell and one patient was admitted due to social reasons and discharged within 48 hrs. COVID19 LAT data was compared to the pre-COVID 12-month period, wherein 35 patients underwent LAT with mean length of stay of 1.91 days and none of the patients were re-admitted within 30 days post procedure. Conclusion Our review suggests elective LAT can be safely performed as a day-case procedure in a tertiary centre with bed day cost savings. There were no significant immediate or late procedure related complications. Further large studies are required to validate our findings.

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