A45-02 Thoracentesis Versus Chest Tube in Undifferentiated Unilateral Pleural Effusion

Abstract Introduction Symptomatic, undiagnosed unilateral pleural effusions are a common cause of hospitalization. Thoracentesis or chest tube (CT) placement are often pursued. In those with new unilateral pleural effusions, it is unknown if a thoracentesis or CT strategy first reduces 30-day follow up pleural procedural burden. Methods In this single-center, retrospective study Slicer Dicer (Epic Systems, Verona, WI, USA), was used to isolate patients who received thoracentesis or chest tube placement using relevant procedural CPT codes between 10/1/2023 to 4/1/2025. Inclusion criteria were age 18 years, first pleural effusion, received thoracentesis or CT placement as initial procedure, required hospital admission, and diagnosis of unilateral pleural effusion by chest X-ray, computed tomography scan, or ultrasound. Exclusion criteria were presence of bilateral pleural effusions, death within the study period, recent thoracic or upper abdominal surgeries or procedures, pre-procedural presence of pneumothorax, high pre-procedural suspicion for hemothorax (e.g., trauma), and failed initial chest tube placement or thoracentesis. Primary outcome was number of ipsilateral pleural procedures within 30 days. Secondary outcomes included total adverse effects. Univariate logistic regression was used to establish odds ratios (ORs) with means and confidence intervals (CIs). Results Four hundred fifty-one patients (656 procedures) met inclusion criteria from a pool of 1901 patients (2,205 procedures): 391 in the thoracentesis group and 63 in the CT group. Total number of procedures in the subsequent 30 days from the index procedure was the same between two groups (thoracentesis vs CT: 1.5 ± 0.6 vs 1.5 ± 0.7 procedures; Δ = 0.01, 95% CI -0.17, 0.18). Any adverse effect was greater in the CT group as compared to the thoracentesis group (thoracentesis vs CT: 26 6.6% vs 22 34.9%; OR 7.5, 95% CI 3.70, 15.2). The CT group had a significantly greater proportion of infection (thoracentesis vs CT: 108 27.6% vs 41 65.1%; OR 4.88, 95% CI 2.70, 9.03), while the thoracentesis group had a significantly greater proportion of heart failure (thoracentesis vs CT: 76 19.4% vs 4 6.3%; OR 0.28, 95% CI 0.07, 0.80) and malignancy (thoracentesis vs CT: 120 30.6% vs 10 15.9%; OR 0.43, 95% CI 0.19, 0.89). Discussion Thirty-day procedural burden was similar among both CT and thoracentesis groups among adult patients who underwent pleural drainage for their index unilateral pleural effusion. The chest tube group had more adverse effects and prevalence of infection. Limitations include limited power, the retrospective nature of the review, and no mention of loculation. This abstract is funded by: None