Abstract Rationale Thoracentesis is a commonly performed diagnostic and therapeutic procedure for managing pleural effusions. Thoracentesis has a well-established safety profile; limited data describes safety and efficacy for outpatient thoracentesis programs. To address this gap, the interventional pulmonary team established an outpatient thoracentesis program led by an advanced practice provider (APP) in collaboration with interventional pulmonologists. This initiative aimed to enhance procedural efficiency, improve access to timely pleural interventions, and optimize resource utilization. We sought to characterize the patient population, evaluate procedural outcomes, and assess the cost implications associated with implementing the APP-led outpatient thoracentesis program. Methods We retrospectively identified patients who underwent thoracentesis in the interventional pulmonary clinic between 2018 and 2025. Demographics, comorbidities, indications, referral sources, laterality, volume removed, pleural fluid characteristics, and effusion etiology were extracted from electronic health records. Procedural safety was assessed by identifying complications, including pneumothorax, bleeding, infection, re-expansion pulmonary edema, syncope, emergency department referral, hospitalization, and death. Patient population, safety, and feasibility metrics were analyzed to determine the cost-effectiveness of an APP-led outpatient thoracentesis model. Results During the study period, 184 patients underwent outpatient thoracentesis. The mean age was 70.9 and 57.1% of patients were male. The cohort was 55.4% White, 27.7% Black, and 15.8% Asian. Most thoracenteses were performed for diagnostic purposes (58.7%). The majority of referrals originated from Pulmonary (48.9%) and Oncology (26.6%), with the remainder from other specialties including Cardiology and Primary Care. Half the effusions were unilateral: 50.0% right-sided, 33.2% left-sided, while 16.8% were bilateral. The mean volume removed was 1,114.6 mL (maximum 4,100 mL). Effusion etiologies were malignancy (49.5%), hepatic hydrothorax (3.3%), congestive heart failure (3.3%), chylothorax (3.3%), and other (40.3%). Patient comorbidities included cardiac disease (59.8%), pulmonary disease (47.0%), renal disease (25.5%), liver disease (8.7%), and inflammatory conditions (8.2%). Complications were rare and included re-expansion pulmonary edema (n = 3; 1.6%), vasovagal syncope (n = 1; 0.5%), and pneumothorax identified on post-procedure chest radiograph (n = 5; 2.7%). After adjudication, only two were true pneumothoraces, and neither required intervention. There were no emergency department visits, hospitalizations, or deaths. Analysis of the APP-led outpatient thoracentesis model indicated thoracenteses performed in the outpatient setting are generally more cost-effective and profitable due to reduced resource utilization. Conclusions Outpatient thoracentesis program provides a safe, effective, and cost-conscious approach to pleural effusion management with low complication rates. APPs are well-suited to lead these models, offering continuity and sustained procedural expertise that enhances access to high-quality, efficient, patient-centered pulmonary care. This abstract is funded by: None
Ruane et al. (Fri,) studied this question.