A45-06 Risk-Stratification in Pleural Intervention for Identifying High-Risk Patients for Post Procedural Pulmonary Complications: A Paradigm Shift From Reactive to Proactive Care

Introduction and Rationale Most patients with pleural disease require pleural interventions for diagnostic and therapeutic purposes. Post Procedural Pulmonary Complication (PPPCs) are common after these pleural interventions which adversely contributes towards patient morbidity and use of hospital resources. Early risk stratification for Post Procedural Pulmonary Complication is a clinical challenge and there are large knowledge-action gaps in this clinical arena. Within this background, this study was conducted with the aim of estimating the Prevalence of Post Procedural Pulmonary Complication (PPPC) and its Risk factors in patients requiring Interventions for Pleural Diseases. Methods This is a Hospital Based prospective observational study conducted at Department of Pulmonary, Critical Care & Sleep Medicine at B. P. Koirala Institute of Health Science (BPKIHS), a university teaching hospital in Nepal. All Patients with Pleural diseases undergoing pleural interventions during the study period of 1 year (July 2023 - June 2024) were enrolled. Post Procedural Pulmonary Complication (PPPC) were defined as the Pulmonary conditions adversely influencing the clinical course after pleural interventions and were graded from grade I to IV depending upon severity. A structured proforma detailed the clinical and procedural data. Descriptive and inferential statistics were used to explore the relationship between clinical and procedure related variables and risk of developing Post Procedural Pulmonary Complication (PPPC). Multivariable logistic regression identified independent risk predictors for risk-stratification. Results During the study period, 80 patients underwent pleural interventions. Pleural effusion (65%), Pneumothorax (25%) followed by Empyema (10%) were dominant diagnosis. The commonest interventions were ICTD (75%) followed by Pigtail Catheter insertion (10%), Medical Thoracoscopy (10%) and Needle thoracocentesis (5%). 20 % Patients developed Post Procedural Pulmonary Complications (PPPCs). The commonest PPPCs were Bronchopleural fistula followed by Pneumonia. 80 % of PPPC were Grade I and II. Comorbidities (COPD/TB/DM/CHF) with OR = 8.82, Recent Respiratory Infection with OR = 20.48, ASA class III/IV with OR = 6.01 and Hypoxemia (SpO2 <90%) with OR = 9.22 independently predicted higher risk for having Post Procedural Complication. A Current Smoker with Co -morbid COPD with ASA III/IV having Spo2 < 90% had >75% Risk of developing PPPC. Conclusions Patients undergoing interventions of Pleural Diseases can be routinely and proactively stratified into different risk categories utilizing combination of easily accessible patient and procedure related risk predictors. This risk stratification represents a paradigm shift, transitioning from reactive approach (treating PPPCs after they occur) to proactive and predictive clinical approach (predicting individual patient’s risk of having PPPCs and tailoring the treatment accordingly). This abstract is funded by: None