PURPOSE: To evaluate the clinical predictors of complications during thoracentesis and to understand the efficacy of ultrasound guidance.
METHODS: We retrospectively reviewed clinical and radiological characteristics of 446 patients who had thoracentesis done between Jan 2003 and Jan 2009 at Portland VAMC.
RESULTS: We found 446 patients, 412 (92.3%) male, mean age was 63.2 (SD ±7.5) yrs. Using Light’s criteria, 238 (53.4%) were transudative and 208 (46.6%) were exudative pleural effusions. Of all effusions, 386 (86.6%) were unilateral and 60 (13.4%) bilateral. Loculation was only found in 27 (6%) effusions. Among the common diagnosis, 136 had congestive heart failure, 125 pneumonia, 118 lung cancer, 33 cirrhosis and 34 others (empyema, post-surgical, metastatic cancers, lymphoma, breast cancer, renal failure, trapped lung, mesothelioma, pulmonary embolism and unknown diagnosis). Only 36 patients were on aspirin, one on aspirin and plavix, 9 were on low-molecular weight heparin at the time of thoracentesis. Mean INR was 1.3 (SD± 0.34) and mean platelet count was 182 (SD ±82). Sixteen(3.5%) complications were noted, all pneumothorax, only 12 required chest tube insertion. In univariate analysis, there was a significant difference in complication rate between ultrasound guidance (3/225) and clinical exam (13/221) method of thoracentesis (p-value 0.0075). Complication rate was significantly higher in therapeutic (14/105) as compared to diagnostic (1/340) thoracentesis (p-value < 0.0001). Complication rate was significantly higher in symptomatic patients (15/118) as compared to asymptomatic patients (1/328) (p value < 0.0001). Complication rate was also found significantly higher in exudative (13/208) as compared to transudative (3/238) effusions (p-value 0.003). No significant difference in complication rate was found in the following groups: anti-platelet therapy, diagnosis, INR and platelet count.
CONCLUSION: Incidence of pneumothorax was significantly lower in ultrasound-guided and diagnostic thoracentesis groups. Symptomatic patients had a significantly higher complication rate, as did patients with exudative pleural effusions.
CLINICAL IMPLICATIONS: Presence of symptoms, therapeutic thoracentesis and exudative effusion were predictors of complications during thoracentesis. Ultrasound guidance lead to a lower rate of complications and should be encouraged during every thoracentesis.
DISCLOSURE: Imran Mohammed, No Financial Disclosure Information; No Product/Research Disclosure Information