Pleural procedures: an audit of practice and complications in a regional Australian teaching hospital

Abstract

BackgroundPleural procedures are essential for the investigation and management of pleural disease and can be associated with significant morbidity and mortality. There is a lack of pleural procedure complication data in the Australian and New Zealand region.AimsTo review pleural procedure practices at Wollongong Hospital with an emphasis on the assessment of complications, use of thoracic ultrasound (TUS), pathology results and comparison of findings with international data.MethodsRetrospective analysis of medical records was performed on pleural procedures identified through respiratory specialist trainee logbooks at Wollongong Hospital from January 2018 to December 2021. Comparison of complication rates was made to the British Thoracic Society 2011 a national pleural audit.ResultsOne hundred and twenty‐one pleural procedures were identified. There were 71 chest drains, 49 thoracocentesis and one indwelling pleural catheter (IPC) insertion. Ninety‐seven per cent of procedures were performed for pleural effusions and 3% for pneumothorax. This audit demonstrated a complication rate (excluding pain) of 16.9% for chest drains and 4.1% for thoracocentesis. This gave an overall complication event rate of 10.8% (excluding pain) for pleural procedures. There was no major bleeding, organ puncture, pleural space infection or death. Bedside TUS was used in 99% of procedures.ConclusionComplication rates for pleural procedures performed by respiratory specialist trainees at Wollongong Hospital are comparable with international outcomes. This audit provides data for comparison on pleural procedure complication rates in Australia. Future studies are required to determine complication rates with IPCs.

Surgical Treatment of Pleural Empyema in Children

“…If the tube is in situ ok, the problem may also be caused by a bronchopleural fistula, especially in cases of necrotizing pneumonia, a complication that sometimes requires endoscopic or autologous blood therapy through drainage [71] and exceptionally with a surgical intervention. Morbidity and mortality from thoracostomy tube or catheter placement are related to the experience and training of the clinician, the indication for placement and the circumstances under which the tube is placed: planned or urgency [72][73][74][75].…”