Quality Gaps and Comparative Effectiveness of Management Strategies For Recurrent Malignant Pleural Effusions.
Chest. 2017 Aug 29;:
Authors: Ost DE, Niu J, Zhao H, Grosu HB, Giordano SH
BACKGROUND: Guidelines for recurrent malignant pleural effusions (MPE) recommend definitive procedures, such as indwelling pleural catheters (IPC) or pleurodesis, over repeat thoracentesis. We hypothesized that many patients have multiple thoracenteses rather than definitive procedures and that this results in more procedures and complications.
METHODS: Retrospective cohort study using SEER-Medicare data from 2007-2011. Patients age 66-90 with a MPE were included. The primary outcome was whether patients with rapidly recurring MPE, defined as recurrence within 2 weeks of first thoracentesis, received guideline consistent care. Guideline consistent care was defined as a definitive second pleural procedure.
RESULTS: Thoracentesis for MPE was performed in 23,431 patients. A second pleural procedure due to recurrence was required in 12,967 (55%). Recurrence was rapid in 7,565 (58%) of the 12,967 patients that had a recurrence. Of the 7,565 patients with rapid recurrence, 1,811 (24%) received guideline consistent care. Definitive pleural procedures as compared to repeat thoracentesis resulted in fewer subsequent pleural procedures (0.62 vs. 1.44 procedures per patient respectively, p<0.0001), fewer pneumothoraxes (<0.0037 vs. 0.009 pneumothoraxes per patient, p=0.001), and fewer emergency room procedures (0.02 vs. 0.04 emergency room procedures per patient, p<0.001). Repeat thoracentesis and IPCs resulted in fewer inpatient days as compared to chest tube or thoracoscopic pleurodesis (0.013 vs. 0.013 vs. 0.085 vs. 0.097 inpatient days per day of life respectively, p<0.001).
CONCLUSIONS: Guideline consistent care using definitive procedures as compared to repeat thoracentesis was associated with fewer subsequent procedures and complications, however pleurodesis resulted in more inpatient days.
PMID: 28864054 [PubMed - as supplied by publisher]