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Master of Public Health

Management of Hepatic Hydrothorax and Effect on Length of Stay, Mortality, Cost, and 30-Day Hospital Readmission

AUTHORS

Sobotka LA , Risaliti C , Hinton A , Michaels A , Hanje AJ , Mumtaz K , Conteh LF , . Journal of gastroenterology and hepatology. 2019 8 23; ().

ABSTRACT

BACKGROUND: Cirrhosis related complications are associated with high inpatient mortality, cost, and length of stay. There is a lack of multi-centered studies on interventions for hepatic hydrothorax and its impact on patient outcomes. The aim of this study was to determine the effect of performing a thoracentesis for hepatic hydrothorax on hospital length of stay, mortality, cost, and 30-day readmission.

METHODS: A retrospective analysis of the Nationwide Inpatient Sample (NIS) between 2002 and 2013 and Nationwide Readmission Database (NRD) during 2013 was performed including patients with a primary diagnosis of hydrothorax or pleural effusion and a secondary diagnosis of cirrhosis based on ICD-9 codes. Univariate and multivariate analyses were performed to determine the effect of thoracentesis on patient outcomes during their hospital stay.

RESULTS: Of the 37,443 patients included from the NIS, 26,889 (72%) patients underwent a thoracentesis. Thoracentesis was associated with a longer length of stay (4.56 days, 95% CI: 2.40-6.72) and higher total cost ($9,449, 95% CI: 3,706-15,191). There was no significant difference in inpatient mortality between patients who underwent a thoracentesis compared to those that did not. Of the 2,371 patients included from the NRD, 870 (33%) were readmitted within 30 days. Thoracentesis was not a predictor of readmission; however TIPS (OR: 4.89, 95% CI: 1.17-20.39) and length of stay (OR: 1.02, 95% CI: 1.001-1.05) on index admission were predictors of readmission.

CONCLUSION: When considering treatment for hepatic hydrothorax, many factors should contribute to determining the best intervention. While performing a thoracentesis may provide immediate relief to symptomatic patients, it should not be considered a long term intervention given it increases hospital cost, was associated with longer length of stays and did not improve mortality.

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