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Chest roentgenography after outpatient thoracentesis
1Department of Internal Medicine, Mayo Clinic Rochester, Minnesota 55905, USA.
Mayo Clinic Proceedings
|October 27, 1998
Summary
Routine chest X-rays after outpatient thoracentesis are costly and rarely detect complications. A selective approach, reserving imaging for symptomatic patients, is recommended for efficient patient care and resource management.
Area of Science:
- Pulmonary Medicine
- Diagnostic Imaging
- Thoracic Procedures
Background:
- Thoracentesis is a common procedure for pleural fluid removal.
- Post-procedure chest roentgenography is often performed to detect complications like pneumothorax.
- The clinical utility and cost-effectiveness of routine post-thoracentesis chest imaging in outpatients are debated.
Purpose of the Study:
- To evaluate the clinical utility of posteroanterior chest roentgenograms after thoracentesis in the outpatient setting.
- To assess the incidence of pneumothorax and the impact of routine imaging on patient management and healthcare costs.
Main Methods:
- Retrospective study of outpatient thoracentesis records from January to December 1996.
- Included 104 procedures meeting exclusion criteria (no pleural biopsy or ultrasound guidance).
- Analyzed indications for thoracentesis and post-procedure chest roentgenography, noting complication rates and costs.
Main Results:
- Of 104 thoracentesis, 54 (52%) had post-procedure chest X-rays.
- Pneumothorax occurred in 5% of procedures (5 patients); 3 were asymptomatic, 2 required hospitalization.
- Routine imaging in asymptomatic patients incurred significant costs ($4,862) with limited therapeutic yield.
Conclusions:
- Routine chest roentgenography after outpatient thoracentesis is costly and inefficient.
- A selective imaging strategy, based on patient symptoms, is recommended.
- This approach optimizes patient care and conserves medical resources.