Thoracentesis outcomes: a 12-year experience

Area of Science:

• Pulmonary Medicine
• Interventional Procedures
• Clinical Outcomes

Background:

• Clinical guidelines and practice patterns often assume thoracentesis safety without sufficient evidence.
• There's a need to evaluate factors influencing complications like iatrogenic pneumothorax, re-expansion pulmonary edema (REPE), and bleeding.

Purpose of the Study:

• To assess demographic and clinical factors associated with thoracentesis complications.
• To evaluate the safety profile of thoracentesis in an inpatient setting.

Main Methods:

• A prospective cohort study of 9320 inpatient thoracenteses performed between August 2001 and October 2013.
• Data collected included fluid volume, procedure details, ventilation status, and needle passes.
• Complications (pneumothorax, REPE, bleeding) were monitored for 24 hours post-procedure.

Main Results:

• Low complication rates observed: 0.61% for iatrogenic pneumothorax, 0.01% for REPE, and 0.18% for bleeding.
• Iatrogenic pneumothorax linked to >1500 mL fluid removal, unilateral procedures, and multiple needle passes.
• Increased fluid removal correlated with a higher risk of REPE; no significant bleeding risk factors identified.

Conclusions:

• Thoracentesis demonstrated a very low complication rate in this large inpatient series.
• Current clinical guidelines and practice patterns may not align with evidence-based best practices for thoracentesis.