Outpatient management of malignant pleural effusion by a chronic indwelling pleural catheter

Background. Previous studies have shown that a chronic indwelling pleural c atheter (PC) safely and effectively relieved dyspnea, maintained quality of life, and reduced hospitalization in patients with malignant pleural effus ions. Outpatient management of malignant pleural effusion with a PC may red uce length of stay and early (7-day) charges compared with inpatient manage ment with chest tube and sclerosis. Methods. A retrospective review of consecutive PC patients (n = 100; 60 out patient, 40 inpatient) were treated from July 1, 1994 to September 2, 1998 and compared with 68 consecutive inpatients treated with chest tube and scl erosis between January 1, 1994 and December 31, 1997. Hospital charges were obtained from date of insertion (day 0) through day 7. Results. Demographics were similar in both groups. Pretreatment cytology wa s positive in 126 of 168 patients (75%), negative in 21 (12.5%), and unknow n in 21 (12.5%). Primary histology included lung (n = 61, 36%), breast (n = 39, 23%), lymphoma (n = 12, 7%), or other (n = 56, 34%). Median survival w as 3.4 months and did not differ significantly between treatment groups. Ov erall median length of stay was 7.0 days for inpatient chest tube and inpat ient PC versus 0.0 days for outpatient Pleurx. No mortality occurred relate d to the PC. Eighty-one percent (81/100) of PC patients had no complication s. One or more complications occurred in 19 patients (19%). Patients treate d with outpatient PC (n = 60) had early (7-day) mean charges of $3,391 +/- $1,753 compared with inpatient PC (n = 40, $11,188 +/- $7,964) or inpatient chest tube (n = 68, $7,830 +/- $4,497, SD) (p < 0.001). Conclusions. Outpatient PC may be used effectively and safely to treat mali gnant pleural effusions. Hospitalization is not required in selected patien ts. Early (7-day) charges for malignant pleural effusion are reduced in out patient PC patients compared with inpatient PC patients or chest tube plus sclerosis patients. (C) 2000 by The Society of Thoracic Surgeons.