Clinical Importance of Surgical Emphysema Post Local Anaesthetic Thoracoscopy—A Multi-Centre Review of Practice

Introduction Local anaesthetic thoracoscopy (LAT) is an important step in the investigation of unexplained exudative pleural effusions. It is increasingly performed as a day case procedure with indwelling pleural catheter (IPC) insertion. Prospective data on complications is unknown. We postulated that post-procedure surgical emphysema (SE) in the absence of an air leak is not a clinical problem. Some centres advocate concurrent IPCs and surgical drains to promote air drainage and avoid SE. Methods We performed a case note review of patients undergoing day case LAT and IPC insertion in 3 United Kingdom (UK) based centres between July 2020 and January 2024. We collected demographics and clinically relevant outcomes. This was registered as a multicentre audit from Northumbria Healthcare (Ref 8491). Results 256 day-case LATs were analysed. Mean age was 72 years (34–86), 93 patients were male. 64 patients (25%) developed post procedure SE, and 4 of those had concurrent air leaks (due to lung shearing away at pneumothorax induction and not iatrogenic visceral puncture). 4 of 64 required post LAT admission with 2 IPCs connected to an underwater seal, and 1 needed a surgical drain. 1 was managed with an ambulatory bag. All other patients with SE were discharged on the day of LAT with no issues. Conclusions In the absence of simultaneous air leaks, the presence of SE is of no clinical importance. The pleural community should move away from including it as a complication. Concurrent drainage of air via IPCs and surgical drains is not required.