Authors (including presenting author) :
Cheng YF, Yau PY, Ling SO, Yim CW, Kwan HY
Affiliation :
Department of Respiratory Medicine, Kowloon Hospital
Introduction :
Pleural effusion is a common condition which could be due to malignant or benign causes. Early diagnosis by pleuroscopy might help improve morbidity and mortality. It’s globally reported diagnostic yield ranged from 80% to 95% but local data is scarce.(1,2) It is now not only available in acute but also in convalescent hospital in Hong Kong. Lack of on-site anaesthetist and surgical support has been considered a deficiency of the later when carrying out invasive intervention. We aim to compare the performance of pleuroscopy in different clinical setting, to facilitate better service planning and future resources allocation.
Objectives :
To compare the safety and diagnostic yield of pleuroscopy in acute and convalescent hospital.
Methodology :
All patients with pleuroscopy performed in Department of Medicine, Tuen Mun Hospital (TMH, acute hospital) and Department of Respiratory Medicine, Kowloon Hospital (KH RMD, convalescent hospital) from July 2016 to June 2019 were recruited. Their demographic data, pleuroscopy results, and clinical outcomes were reviewed. Diagnostic yield was determined by cross-checking the pleuroscopy diagnosis with final diagnosis confirmed by other additional investigation. Performance in TMH and KH RMD was compared by applying a case-control design to the two groups that were propensity score matched to sex, age and Charlson Comorbidity Index(CCI).
Result & Outcome :
During the study period, 72 patients and 41 patients underwent pleuroscopy in TMH and KH RMD respectively. There is no significant difference in sex (25 male (61.0%) from TMH and 22 male patients (53.7%) from KH RMD), age (mean age 72 years (69.0-75.5) in TMH and 75 years (71.6 – 78.5) in KH RMD), and Charlson Comorbidity Index (3.59 (3.09-4.08) in TMH and 4.17 (3.61-4.73) in KH RMD).
In the propensity score matched analysis, the 41 patients from KH RMD were matched to 41 patients from TMH. Sensitivity of pleuroscopy in diagnosing local disease was comparable in the two hospitals (76.4% from TMH and 79.4% from KH RMD, p=0.791). KH RMD seems to have a shorter post-pleuroscopy chest drain duration and lower complication rates but they were not statistically significant (Mean post-pleuroscopy chest drain duration was 8 days in TMH vs 5 days in KH RMD, p=0.057; complication rates were 26.8% in TMH and 19.5% in KH RMD, p=0.432).
We found that pleuroscopy could be performed safely in both acute and convalescent hospitals with a similar diagnostic yield. Performing elective invasive intervention with adequate safety precaution in convalescent hospital could help relieving the patient load in acute hospitals thus potentially reduce the waiting time.
