Thoracoscopy with Talc Pleurodesis Shortens Hospitalization

Abstract

A retrospective review of patients with recurrent symptomatic pleural effusions was done to assess whether thoracoscopy with talc pleurodesis shortens chest tube duration and hospital length of stay while maintaining a satisfactory success rate compared with thoracostomy. Thirty consecutive patients with recurrent symptomatic malignant or undiagnosed pleural effusions underwent 32 thoracoscopies with talc pleurodesis (74% women; mean age, 59.4 years). They were compared with 47 historic control subjects who underwent 50 chest tube thoracostomies and pleurodesis with doxycycline (55% women; mean age, 59.6 years). Patients were followed for 6 months. Failure of pleurodesis was defined as reaccumulation of a symptomatic effusion, continued chest tube drainage at the time of death, or the need for subsequent drainage procedures. The majority of the effusions were the result of malignant disease. Thoracoscopy was successful for 91% (29 of 32) of the procedures performed. The mean length of hospital stay was 4.6 days with a mean chest tube duration of 3.1 days. This was significantly less than the control group, which had a mean length of stay of 13.9 days and a mean chest tube duration of 7.3 days (p < 0.001). Thoracoscopy is an effective mode of relieving symptomatic pleural effusions. The procedure is minimally invasive with a low incidence of complications. It shortens hospital length of stay, which can translate into lower healthcare cost and improved quality of life in patients with a limited life expectancy.