P178 Ambulatory care of primary spontaneous pneumothorax with a Pneumostat device – cost effective and safe

Introduction and objectives A Heimlich Valve attached to an intercostal drain facilitates the ambulatory management of primary spontaneous pneumothorax (PSP) and in selected individuals permits outpatient care. We have 3 years of experience in doing this with Atrium’s Pneumostat device. We ascertained the safety and cost effectiveness of this ambulatory pathway. Methods We conducted a retrospective evaluation of all patients presenting with a PSP from March 2013 to December 2014. Data was collected on management, length of stay (LOS) and complications. Outpatients with a Pneumostat are advised to attend the chest clinic 24 h after bubbling stops for review for drain removal, or earlier if any concerns. Medical bed days saved was calculated as time at home with the device in situ , as standard BTS care would require an inpatient stay with a drainage bottle. Results 73 patients presented with a PSP. 34 patients required chest tube drainage, 24 of which were managed as an outpatient with a Pneumostat . The median LOS in the outpatient group was 1.0 day (IQR 0.0–2.0 days) vs 3.5 days (IQR 1.3–7.0 days) in the inpatient group. A total of 98 bed days were saved using the device. Based on a cost of £25.70 per Pneumostat and £312 per bed day, the overall saving was £29,959.20. Patients who required thoracic surgery were kept on the “inpatient waiting list” and could be admitted directly from home. In the outpatient group, there was 1 drain site infection, 1 drain displacement and 1 patient failed to attend follow-up but returned a week later with a resolved pneumothorax. Conclusion Pneumostat devices have recently been withdrawn from use in the United States by FDA decree. Although legal in the UK and supported by the MHRA, a Certificate of Medical Necessity is required to purchase the devices and there is no alternative “all-in-one” solution that attaches to a standard chest drain. Our data shows that this device is safe in uncomplicated PSP and confers significant financial savings. These benefits should not be overlooked and a consensus statement is required to ensure their continued use in the UK.