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The optimal management for patients with recurrent malignant pleural effusions (MPE) remains unclear. This study intends to identify what differences in demographics, underlying diagnosis, initial radiographic findings, and outcomes exist between those who receive repeat thoracentesis (RT) versus indwelling pleural catheter (IPC) for the management of MPE. This study is a retrospective review of data from MIMIC-IV, an open-access database derived from the electronic health records of Beth Israel Deaconess Medical Center from 2008 to 2019. A total of 471 patients with MPE were selected, including 196 patients managed with RT without an IPC and 275 patients managed with an IPC. Patients receiving only a single diagnostic thoracentesis or with missing data were excluded from analysis. Radiology reports for the first chest CT performed after admission were reviewed for the presence of 61 pathologic findings as well as MPE size and laterality. All features of interests were compared using Pearson's chi-squared tests and independent t-tests. P < 0.05 was considered significant. The final cohort was 54.8% (258/471) female and 45.2% (213/471) male with a mean age of 66.9 years. The respiratory system was the most common primary site for malignancy and comprised 40.4% (190/471) of cases. No significant demographic differences were observed for age, primary cancer site, sex, BMI, race, or insurance type between groups. Patients who received RT without IPC had significantly longer hospital courses (12.4 days vs 8.0 days, P < 0.001) and a higher in-hospital mortality rate (15.3% vs 9.1%, P < 0.05) compared with IPC management. There was no significant difference in time to death between groups. No differences were observed for the size and location characterization of the MPE on chest CT. The key findings of lymphadenopathy was noted more often in the RT group (88.9% vs 80.6% P < 0.006) while herniation (11.1% vs 22.2%, P < 0.009) was noted more often within the IPC group. Patients who received an IPC had a reduced in-hospital mortality and shorter length of stay relative to those who were managed with RT alone. Findings on chest CT at admission were similar with the exception of the key findings of lymphadenopathy in RT and herniation in IPC. Further studies are necessary to identify the influence of prognostic factors for guiding patient selection with these procedures.
Spalinski et al. (Wed,) studied this question.