Clinical Impact of a Pleural Unit in a Tertiary Level Hospital

Area of Science:

• Pulmonology
• Thoracic Medicine
• Hospital Management

Background:

• Pleural diseases contribute significantly to hospital admissions and prolonged stays.
• The establishment of a dedicated Pleural Unit (PU) aimed to optimize the management of these conditions.
• Evaluating the clinical impact of a PU is crucial for improving patient outcomes and resource utilization.

Purpose of the Study:

• To assess the clinical impact of a newly created Pleural Unit (PU) on the management of pleural diseases.
• To compare patient outcomes before and after the implementation of the PU.
• To analyze the effect of the PU on admission rates, length of stay, readmissions, and mortality.

Main Methods:

• Prospective study including 741 patients admitted to the PU for primary spontaneous pneumothorax (PSP), secondary spontaneous pneumothorax (SSP), complicated parapneumonic pleural effusion (CPPE), and malignant pleural effusion (MPE) from 2015-2018.
• Analysis of descriptive parameters, mean length of stay, 1-month readmissions, surgical needs, and in-hospital mortality (for CPPE).
• Comparison with data from patients admitted to the respiratory medicine department for the same conditions during 2013-2014.

Main Results:

• A progressive decrease in total admissions and mean length of stay was observed for PSP, SSP, and CPPE following PU implementation.
• Mean length of stay for CPPE decreased from 18.3 to 11.3 days (P=.001), and for PSP from 6.2 to 4.2 days (P=.004).
• Hospital readmissions at 1 month and in-hospital mortality for CPPE significantly reduced from 14.9% to 5.5% (P=.021).

Conclusions:

• The creation of a Pleural Unit can lead to a reduction in unnecessary hospital admissions.
• Implementation of a PU is associated with decreased mean lengths of stay for various pleural diseases.
• A PU can significantly lower in-hospital mortality, particularly in cases of complicated parapneumonic effusion.