RESULTS: Over a 2-year period, 99 patients underwent definitive interventions for MPE. Data on the clinical course leading to definitive palliation was available in 69 patients, who underwent 72 definitive procedures (68 indwelling pleural catheter insertions and 4 thoracoscopic talc insufflations). The clinical course leading to definitive palliation was considered “ideal” in 36/72 (50%) cases, with patients undergoing ≤ 2 therapeutic thoracenteses, no chest tube insertions, ≤ 1 ER visit, and no hospital admissions. In the remaining patients, a mean of 2.4 (SD 1.65) pleural procedures were performed during the period leading to definitive palliation. Tube thoracostomy (without pleurodesis) was performed in 27/72 (38%) cases, with the chest tubes remaining in place for an average of 3.7 days (SD 3.0). Hospitalization for symptomatic MPE preceded definitive palliative intervention in 28/72 (39%) cases. Patients who initially presented to the ER with symptomatic MPE were more likely to undergo chest tube insertion and hospital admission.