Introduction Data on indications, outcomes and complications of IPCs from clinical trials has been published.1 This audit examined differences in practice and outcomes between clinical trials and day-to-day working which may influence the pleural service and provide information to other hospitals considering introducing this service.
Method We retrospectively reviewed patient-related data and outcomes for IPCs inserted at our hospital from February 2011 until December 2013. We compared the findings to secondary outcomes of the IPC arm of the TIME2 trial.1
Results 102 IPCs were placed into 93 patients: 43 as inpatients; 59 as outpatients. 20 inpatients and 23 outpatients had previous talc pleurodesis.
10 patients had microbiological isolation of pleural fluid throughout a total of 27.3 IPC years; not all were associated with clinical signs of a pleural infection. Only 12 (50%) patients with a C-reactive protein of >200 mg/l had a sample of their pleural fluid sent for culture.
Drain removal occurred in 23% of the inpatient IPCs and 29% of the outpatient compared to 57% in the TIME2 trial.
The median inpatient stay after elective pleurodesis in an outpatient was 1.5 nights in 2011 (range 0–11), 1 night in 2012 (range 0–5) and 0 nights in 2013 (range 0–5).
Conclusion The TIME2 cost analysis was based on a median stay of 0 nights which has been replicated in our hospital this year. The optimisation of community support and increasing confidence with the procedure led to reductions in inpatient stays.
The rate of IPC removal was substantially less common in our cohort and the indication for removal was often not due to spontaneous pleurodesis alone unlike the TIME2 trial. Indications for removal included infection, pain and blockage as well as pleurodesis. The data from our centre did not exclude any patients, including those who died, and the follow up period often continued beyond 6 months.
Some large differences exist between the TIME2 trial data and our cohort. While this could reflect a different patient population and setting, it could also highlight differences in outcomes between controlled clinical trials and day-to-day practice.
Davies HE et al. JAMA 2012;307(22):2383–9
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