The Outcome of Thoracentesis versus Chest Tube Placement for Hepatic Hydrothorax in Patients with Cirrhosis: A Nationwide Analysis of the National Inpatient Sample

Abstract

There are only a few studies with a small sample size of patients that have compared the risks of using chest tubes versus thoracentesis in hepatic hydrothorax. It has been shown that many complications may arise secondary to chest tube placement and is associated with increased morbidity and mortality. In this retrospective study, patients with cirrhosis were identified from the 2009 National Inpatient Sample by using ICD-9 codes; we evaluated the risk of chest tube versus thoracentesis in a largest population with hepatic hydrothorax to date to measure the mortality and the length of stay. A total of 140,573 patients with liver cirrhosis were identified. Of this, 1981 patients had a hepatic hydrothorax and ended up with either thoracentesis (1776) or chest tube (205). The mortality in those who received a chest tube was two times higher than that in thoracentesis group with a P value of ≤0.001 (CI 1.43–312). In addition, the length of hospital stay of the chest tube group was longer than that of the thoracentesis subset (7.2 days versus 3.8 days, resp.). We concluded that chest tube placement has two times higher mortality rate and longer hospital length of stay when compared to patients who underwent thoracentesis.

Pleural Effusion Outcomes in Intensive Care: Analysis of a Large Clinical Database

“…This has been demonstrated in studies of cirrhotic patients who experience greater mortality and longer length of stay with chest tube drainage than with thoracentesis. 30,31 It would also be valuable to compare pleural fluid drainage procedures with aggressive diuresis in patients who have a positive fluid balance and whose pleural effusions are most likely secondary to volume overload. 2,9 In addition, future studies should evaluate pleural fluid drainage for its various purposes: improved diagnostics, improved pulmonary mechanics or oxygenation, or stopping clinical deterioration.…”

Multidisciplinary Management of Hepatic Hydrothorax in 2020: An Evidence‐Based Review and Guidance

“…( 70 ) In a recent retrospective study of 140,573 patients with liver cirrhosis, among whom 1,981 had HH requiring thoracentesis (1,776) or chest tube (205), hospital length of stay and mortality rate for chest tube patients were double those for thoracentesis patients. ( 71 ) For these reasons, the American Association for the Study of Liver Diseases guidelines state that “Chest tube insertion is contraindicated in patients with hepatic hydrothorax.” ( 32 ) Chest tube, however, may be indicated in the management of infected pleural fluid (Table 1), preferably with a smaller‐bore (<20 F) drain. The details of chest tube placement and management are beyond the scope of this review but could be of interest to the reader when infected pleural fluid is encountered.…”

Case Report: Indwelling Pleural Catheter Based Management of Refractory Hepatic Hydrothorax as a Bridge to Liver Transplantation

“…High volume drainage of fluid and re-accumulation of pleural fluid on clamping intercostal drains is characteristic. As a result, repeat thoracentesis has been the routine procedure for removal of pleural fluid from the pleural cavity and has been shown to have reduced mortality and hospital stay compared to chest drain insertion ( 16 ). However, a single centre retrospective review of patients undergoing thoracentesis showed the cumulative risk of complications increased with sequential thoracenteses ( 17 ), with increased risk of haemothorax with thrombocytopenia and higher MELD scores (Model for End-Stage Liver Disease which stratifies severity of liver disease).…”