Outcomes and Complications of Thoracentesis in Hospitalized Patients

Despite the common performance of thoracentesis, predicting risk for adverse outcomes and abnormal postprocedural findings remains difficult. Although guidelines and experts have suggested that routine postprocedure imaging has low yield, compliance with these guidelines has not been well studied. In addition, previous studies have shown that pleural effusions are associated with high short-term mortality rates, longer hospitalizations, and higher readmission rates, increasing the importance of systematic study of procedural results. We aimed to determine the rate of imaging abnormalities, the utility of routine postprocedure imaging, and health outcomes for hospitalized patients requiring thoracentesis.

An epidemiologic description including adult inpatients at one academic medical center who underwent thoracentesis outside of radiology-specialty procedural areas during a 2-year period. Charts were individually reviewed for data extraction.

In total, 425 thoracentesis procedures in 329 patients were included. A chest x-ray was obtained after 80.9% of procedures. Postprocedure imaging abnormalities included pneumothorax (8.0%), hemothorax (1.6%), reexpansion pulmonary edema (7.8%), and pneumothorax ex vacuo (4.7%). The average hospital length of stay was 13 days, and 15% required mechanical ventilation during their hospitalization. Fifty-five percent of participants were discharged home, 22.8% to a medical facility, 14.4% transitioned to hospice care, and 8.1% died during hospitalization.

Overall, approximately 20% of patients required clinical reassessment or intervention following thoracentesis. The findings confirm a high rate of secondary morbidity, in-hospital mortality, and long length of stay for hospitalized patients undergoing thoracentesis. The requirement for inpatient thoracentesis represents an opportunity to address end-of-life issues and to identify approaches to optimize resource utilization.