CT-guided lung biopsy service with conservative management of pneumothorax

TL;DR

This study shows that most patients who get a collapsed lung after a lung biopsy can be safely treated as outpatients, reducing hospital stays and improving efficiency.

Contribution

The paper introduces a safe outpatient pathway for managing pneumothorax after CT-guided lung biopsy, increasing procedural capacity.

Findings

20.2% of patients developed pneumothorax, but 90.4% were successfully managed without immediate intervention.

Outpatient management increased biopsy capacity from two to three per session without compromising safety.

Structured follow-up ensured patient stability with minimal care escalation.

Abstract

•Most patients who develop iatrogenic pneumothorax following CTGB can be managed conservatively via ambulatory care.•CTGB of lung can be done without reserving an inpatient recovery bed for patient undergoing the procedure.•Most patients with small pneumothorax can be discharged after they are observed for 1 h and had repeat CXR.

Most patients who develop iatrogenic pneumothorax following CTGB can be managed conservatively via ambulatory care.

CTGB of lung can be done without reserving an inpatient recovery bed for patient undergoing the procedure.

Most patients with small pneumothorax can be discharged after they are observed for 1 h and had repeat CXR.

CT-guided lung biopsy (CTGB) is a critical diagnostic tool for pulmonary lesions but is associated with a significant risk of pneumothorax, requiring inpatient observation in some cases. Limited hospital bed availability within the NHS constrains procedural capacity and prolongs waiting times. This study evaluates the safety and efficiency of an outpatient CTGB service integrated with an ambulatory pneumothorax management pathway.

A retrospective analysis of 213 patients scheduled for CTGB between March 2021 and June 2023 was conducted. Patients developing pneumothorax were stratified for outpatient management based on haemodynamic stability, symptom severity and home support availability. Follow-up included clinical assessments and serial chest X-rays at 24–48 h, 1 week, 3 weeks and 7 weeks post-procedure.

Of 207 patients who underwent CTGB, 42 (20.2%) developed pneumothorax, with 39 meeting ambulatory management criteria. Thirty-eight (90.4%) were successfully managed without immediate intervention, and four (9.5%) required later intervention, including chest drain insertion or aspiration. The implementation of the conservative management of pneumothorax increased procedural capacity from two to three biopsies per session, reducing waiting times without compromising patient safety.

Ambulatory management of post-CTGB pneumothorax is safe and effective, reducing inpatient admissions and optimising hospital resources. The structured follow-up pathway ensured patient stability, with minimal need for escalation of care. Our findings support broader implementation of this model to improve healthcare efficiency while maintaining high standards of patient care.

Figures