Ultrasonography guidance reduces complications and costs associated with thoracentesis procedures

Abstract

PURPOSE.: We performed an analysis of hospitalizations involving thoracentesis procedures to determine whether the use of ultrasonographic (US) guidance is associated with differences in complications or hospital costs as compared with not using US guidance. METHODS.: We used the Premier hospital database to identify patients with ICD-9 coded thoracentesis in 2008. Use of US guidance was identified using CPT-4 codes. We performed univariate and multivariable analyses of cost data and adjusted for patient demographics, hospital characteristics, patient morbidity severity, and mortality. Logistic regression models were developed for pneumothorax and hemorrhage adverse events, controlling for patient demographics, morbidity severity, mortality, and hospital size. RESULTS.: Of 19,339 thoracentesis procedures, 46% were performed with US guidance. Mean total hospitalization costs were $11,786 (±$10,535) and $12,408 (±$13,157) for patients with and without US guidance, respectively (p < 0.001). Unadjusted risk of pneumothorax or hemorrhage was lower with US guidance (p = 0.019 and 0.078, respectively). Logistic regression analyses demonstrate that US is associated with a 16.3% reduction likelihood of pneumothorax (adjusted odds ratio 0.837, 95% CI: 0.73-0.96; p= 0.014), and 38.7% reduction in likelihood of hemorrhage (adjusted odds ratio 0.613, 95% CI: 0.36-1.04; p = 0.071). CONCLUSIONS.: US-guided thoracentesis is associated with lower total hospital stay costs and lower incidence of pneumothorax and hemorrhage. © 2011 Wiley Periodicals, Inc. J Clin Ultrasound, 2011.

Ultrasound guidance reduces pneumothorax rate and improves safety of thoracentesis in malignant pleural effusion: report on 445 consecutive patients with advanced cancer

“…Thoracentesis by interventional radiologists under US guidance include the necessity of moving the patient to the radiology suite with the additional cost of the procedure in the US suite [1]. Although interventional US guidance is well-established in such specialties as radiology, cardiology, and obstetrics and gynecology, it is becoming more common across a range of specialties and procedures [17]. …”

The efficacy of bedside chest ultrasound: from accuracy to outcomes

“…This has been confirmed in the database studies mentioned above, with a 6% reduction in total hospitalisation cost [126,127]. In addition, if radiology-performed ultrasound guidance is substantial delayed, clinician-performed ultrasound guidance provides further cost-benefit [132].…”

“…Observational studies using insurance databases have confirmed a reduction in pneumothorax and haemorrhagic complications with ultrasound guidance [126,127].…”

Ultrasound Guidance in Detection of Pneumothorax and Thoracentesis Performance:a Review

“…In a systematic review and meta-analysis, Gordon (2010) revealed the best way to lessen the pneumothorax rates after thoracentesis is considering the US. Patel (2012) (Shojania 2001;PPACA, 2012;DHHS, 2012). US is an easily learned technique which is portable and effective in a reliable physical exam and could provide real-time guidance for thoracentesis and other procedures (Feller-Kopman, 2007).…”