PURPOSE: Approximately 1.5 million patients in the United States are diagnosed with pleural effusion each year, and thoracentesis is the mainstay of management. Ultrasound guidance is not consistently used for the procedure despite the fact that it has been shown to reduce complications. The objective of our analysis was to assess whether hospitalization costs and adverse events differ among patients who undergo thoracentesis with ultrasound guidance versus without.
METHODS: We used the Premier Perspective(tm) hospital database to identify patients with a primary ICD-9 procedure code of 34.91 (thoracentesis) in 2008. Use of ultrasound guidance technology was identified using CPT-4 procedure codes. Data on total hospital costs and adverse events associated with thoracentesis were also evaluated. We performed univariate and multivariable analyses of cost data and adjusted for patient demographics, hospital characteristics, and patient morbidity severity. Costs were log-transformed to adjust for skewness. A logistic regression model was developed for pneumothorax adverse events, controlling for patient morbidity severity, mortality, and hospital size.
RESULTS: Out of 19,339 thoracentesis procedures, 8,824(46%) were performed with ultrasound. Mean hospitalization costs were $11,786 (± $10,535) and $12,408 (± $13,157) for patients managed with and without ultrasound, respectively (p< .001). Risk of pneumothorax was statistically significant lower with ultrasound guidance with a p value=0.018. To investigate this further, a logistic regression was run for pneumothorax while controlling for patient and hospital covariates. Results of these adjusted models demonstrate that ultrasound is associated with a reduction in the complication of pneumothorax with an odds ratio of .840, (95% CI: .729 to .968) and a p-value of .016.
CONCLUSION: Findings suggest that ultrasound-guided thoracentesis is associated with lower hospital costs and a lower incidence of pneumothorax.
CLINICAL IMPLICATIONS: There is a growing body of literature supporting the use of ultrasound guidance during thoracentesis procedures. Its use should be considered and hospital decision-makers should consider policies to routinely incorporate it into clinical practice.
DISCLOSURE: Pankaj Patel, Grant monies (from industry related sources) Candace Gunnarsson is a paid consultant to GE HealthCare; No Product/Research Disclosure Information