Abstract Rationale Thoracentesis remains a fundamental diagnostic and therapeutic procedure in pulmonary medicine. However, inflation-adjusted reimbursement has demonstrated a compound annual growth rate (CAGR) of approximately -3.3% to -4.4%, raising concern about procedural sustainability. We examined national thoracentesis utilization and institutional predictors from 2017-2022 to assess whether financial pressures have influenced practice patterns and access across hospital settings. Methods We conducted a retrospective cohort study using the National Inpatient Sample (2017-2022). Adult hospitalizations with pleural effusions were identified using ICD-10-CM codes, and thoracentesis procedures were defined by ICD-10-PCS codes. Analyses incorporated survey weights to generate nationally representative estimates. Multivariable survey-weighted logistic regression identified independent predictors of thoracentesis, adjusting for hospital rurality, teaching status, bed size, payer, ZIP-income quartile, race, sex, age, and region. Marginal predicted probabilities were computed across years and stratified by institutional characteristics. Results Across 2017-2022, thoracentesis utilization among pleural effusion hospitalizations remained stable. The crude rate ranged from 306 per 1,000 discharges in 2017 to 322 per 1,000 in 2019 before returning to 315 per 1,000 in 2022. Despite small fluctuations, the adjusted model showed no significant temporal trend (predicted probability 0.315 in 2017 vs 0.316 in 2022; p = 0.73). The most significant disparity occurred in rural hospitals, where patients had 31% lower odds of thoracentesis than urban hospitals (aOR 0.69, 95% CI 0.66-0.71, p 0.001). Teaching hospitals also had lower odds (aOR 0.91, 95% CI 0.88-0.94, p 0.001), while medium-sized hospitals showed slightly higher odds (aOR 1.05, 95% CI 1.02-1.08, p = 0.001). Racial and regional differences were significant: Black (aOR 0.91), Hispanic (aOR 0.95), and Asian (aOR 0.90) patients were less likely to undergo thoracentesis than White patients (p 0.001 for all), and hospitals in the Midwest (aOR 1.38), South (aOR 1.24), and West (aOR 1.37) had higher odds than those in the Northeast (p 0.001). Older age strongly predicted thoracentesis (aOR 1.012 per year, p 0.001), while higher-income ZIP codes and private insurance were linked to modestly reduced odds (p 0.001). Conclusions From 2017-2022, thoracentesis utilization remained stable nationally despite a declining reimbursement CAGR of approximately -4%. However, persistent disparities by geography, hospital type, and race suggest that economic pressures have not reduced overall use but may reinforce inequities in procedural access and training exposure. Reimbursement alignment and institutional support are needed to sustain equitable thoracentesis access nationwide. This abstract is funded by: None
Cho et al. (Fri,) studied this question.