Introduction Pleural effusions are a common respiratory problem and account for 20,000 hospital episodes annually. 70% of patients need admission of 7 days or more (1). Treatment options include pleurodesis and long term indwelling pleural catheters (IPC)(2). Traditionally, management has involved recurrent lengthy hospital admissions which are both inconvenient for the patient and expensive. To reduce these problems, we admit patients to an elective short stay ward where they undergo pleurodesis and are discharged after 1–2 days.
Aim To assess the effectiveness of pleurodesis in patients admitted to an elective short stay ward.
Method We retrospectively reviewed 33 patients who were managed on an elective ward. A 12F Chest drain was inserted followed by administration of 4g sterile talc. Patients who did not re-attend with an effusion within in the following six months, or prior to dying were considered a success.
Results During 2009–2010, 33 patients with an average age of 66.5 years underwent pleurodesis on the elective short stay ward. 23/33 patients did not re-attend with an effusion within six months (70%). However, 10 re-attended with a recurrent effusion despite talc (30%). Of these, 3 patients had trapped lung on their xray and 1 had a chylothorax. Both are reported causes of failure (2).Chest drains stayed in for 1–2 days, with an average inpatient stay of 2 days. 18/33 patients died within 3 months of admission (54%). Of the 10 that re-attended, 6 died within 3 months (60%). There were no complications resulting from this procedure.
Conclusions Patients who are admitted to an elective short stay ward are managed safely and effectively. They require a shorter inpatient hospital stay which is cost-effective. Our results illustrate 70% of patients did not require an IPC but treatment with pleurodesis alone was sufficient to prevent re-attendances.Most patients do not require an acute hospital admission. Patients who do re-attend with a recurrent effusion due to trapped lung can be considered for IPC.
Hospital statistics for pleural effusion. DoH.2002–2003. (Accessed June 2013) www.rightdiagnosis.com/p/pleural_effusion/stats.htm.
Roberts ME, Neville E et.al. BTS Pleural Disease Guideline. Management of a malignant pleural effusion: Thorax;2010;65(2)