The safety of medical thoracoscopy in a group at high risk for complications

The use of medical thoracoscopy (MT) for the diagnosis and/or palliative treatment of pleural effusions is expected to become more widespread in the coming years. The aims of the present study were to establish the safety of MT in a group of patients at high risk for complications and to determine the factors that affect the development of complications.

A total of 355 patients who underwent MT were divided into 2 groups: patients at high risk for complications and patients who had no risk factor. After the procedure, the complications of MT were recorded. All patients were followed up for at least 24 months. To evaluate the relationship between variables and complications, logistic regression models were applied.

Of the 355 patients, 106 had one or more risk factors, whereas 249 did not have any risk factor. Pain (12.3%) was the most frequent complication in the high-risk patients, and subcutaneous emphysema (10.3%) was the most frequently reported complication in the normal-risk patients. Only pain was observed more frequently in the high-risk patients compared with the normal-risk patients. Talc pleurodesis was associated with prolonged air leak (8.3%) and empyema (5%). The percentage of patients with no complication was 58.6%. The mortality rate was 0.28%. In the multivariate analysis, the presence of mesothelioma was identified as a factor that increased the risk of complication.

MT is a safe method for the diagnosis of patients with pleural effusion, even in patients at high risk for complications. However, complications, found in approximately half of the patients, should also be examined in terms of cost.