Limited Clinical Utility of Chest Radiography in Asymptomatic Patients after Interventional Radiology-Performed Ultrasound-Guided Thoracentesis: Analysis of 3,022 Consecutive Patients
Purpose The aim of this study was to report the utility of chest radiography following interventional radiology-performed ultrasound-guided thoracentesis. Materials and Methods A total of 3,998 patients underwent thoracentesis between 2003 and 2018 at two institutions. A total of 3,022 (75.6%) pati...
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2021-06-01
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| Series: | Journal of Clinical Interventional Radiology ISVIR |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1723096 |
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| author | Jacob J. Bundy Anthony N. Hage Ruple Jairath Albert Jiao Vibhor Wadhwa Narendra B. Gutta Ravi N. Srinivasa Joseph J. Gemmete Eric J. Monroe Jeffrey Forris Beecham Chick |
| author_facet | Jacob J. Bundy Anthony N. Hage Ruple Jairath Albert Jiao Vibhor Wadhwa Narendra B. Gutta Ravi N. Srinivasa Joseph J. Gemmete Eric J. Monroe Jeffrey Forris Beecham Chick |
| author_sort | Jacob J. Bundy |
| collection | DOAJ |
| description | Purpose The aim of this study was to report the utility of chest radiography following interventional radiology-performed ultrasound-guided thoracentesis.
Materials and Methods A total of 3,998 patients underwent thoracentesis between 2003 and 2018 at two institutions. A total of 3,022 (75.6%) patients were older than 18 years old, underwent interventional radiology-performed ultrasound-guided thoracentesis, and had same-day post-procedure chest radiograph evaluation. Patient age (years), laterality of thoracentesis, procedural technical success, volume of fluid removed (mL), method of post-procedure chest imaging, absence or presence of pneumothorax, pneumothorax size (mm), pneumothorax management measures, and clinical outcomes were recorded. Technical success was defined as successful aspiration of pleural fluid. Post-procedure clinical outcomes included new patient-perceived dyspnea and hypoxia (oxygen saturations < 90% on room air). Costs associated with radiographs were estimated using Medicare and Medicaid fee schedules.
Results Mean age was 56.7 ± 15.5 years. Interventional radiology-performed ultrasound-guided thoracentesis was performed on the left (n = 1,531; 50.7%), right (n = 1,477; 48.9%), and bilaterally (n = 14; 0.5%) using 5-French catheters. Technical success was 100% (n = 3,022). Mean volume of 940 ± 550 mL of fluid was removed. Post-procedure imaging was performed in the form of posteroanterior (PA) (2.6%; 78/3,022), anteroposterior (AP) (17.0%; 513/3,022), PA and lateral (77.9%; 2,355/3,022), or PA, lateral, and left lateral decubitus (2.5%; 76/3,022) chest radiographs. Post-procedural pneumothorax was identified in 21 (0.69%) patients. Mean pneumothorax size, measured on chest radiograph as the longest distance from the chest wall to the lung, was 18.8 ± 10.2 mm (range: 5.0–35.0 mm). Of the 21 pneumothoraces, 7 (33.3%) were asymptomatic, resolved spontaneously, and had a mean size of 6.4 ± 2.4 mm. Fourteen pneumothoraces, of mean size 25.0 ± 5.8 mm, required management with a pleural drainage catheter (66.6%). The overall incidence of pneumothorax requiring pleural drainage catheter placement following interventional radiology-performed ultrasound-guided thoracentesis was 0.46% (14/3,022). Of the patients requiring drainage catheter placement, 12/14 (85.7%) and 13/14 (92.9%) had dyspnea and hypoxia, respectively. Potential costs to Medicare and Medicaid, for chest radiographs, in this study, were $27,547 and $10,581, respectively.
Conclusion The incidence of clinically significant pneumothorax requiring catheter drainage following interventional radiology-operated ultrasound-guided thoracentesis is exceedingly low (0.46%), and routine post-procedure chest radiographs in asymptomatic patients provide little value. Reserving post-procedure chest radiographs for patients with post-procedure dyspnea or hypoxia will result in more efficient resource utilization and health care cost savings. |
| format | Article |
| id | doaj-art-d7fa58eb4bb748e0974c39d710c6eba6 |
| institution | OA Journals |
| issn | 2456-4869 |
| language | English |
| publishDate | 2021-06-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Journal of Clinical Interventional Radiology ISVIR |
| spelling | doaj-art-d7fa58eb4bb748e0974c39d710c6eba62025-08-20T02:03:54ZengThieme Medical and Scientific Publishers Pvt. Ltd.Journal of Clinical Interventional Radiology ISVIR2456-48692021-06-0150208609010.1055/s-0041-1723096Limited Clinical Utility of Chest Radiography in Asymptomatic Patients after Interventional Radiology-Performed Ultrasound-Guided Thoracentesis: Analysis of 3,022 Consecutive PatientsJacob J. Bundy0Anthony N. Hage1Ruple Jairath2Albert Jiao3Vibhor Wadhwa4Narendra B. Gutta5Ravi N. Srinivasa6Joseph J. Gemmete7Eric J. Monroe8Jeffrey Forris Beecham Chick9Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, United StatesDepartment of Radiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, United StatesDepartment of Neuroscience, University of Evansville, Evansville, Indiana, United StatesMichigan State University College of Human Medicine, Grand Rapids, Michigan, United StatesDivision of Interventional Radiology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY 10065, United StatesDepartment of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United StatesDepartment of Interventional Radiology, University of California Los Angeles, Los Angeles, California, United StatesDivision of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, United StatesSection of Interventional Radiology, Department of Radiology, University of Washington, Seattle Children’s Hospital, Seattle, Washington, United StatesDivision of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, Washington, United StatesPurpose The aim of this study was to report the utility of chest radiography following interventional radiology-performed ultrasound-guided thoracentesis. Materials and Methods A total of 3,998 patients underwent thoracentesis between 2003 and 2018 at two institutions. A total of 3,022 (75.6%) patients were older than 18 years old, underwent interventional radiology-performed ultrasound-guided thoracentesis, and had same-day post-procedure chest radiograph evaluation. Patient age (years), laterality of thoracentesis, procedural technical success, volume of fluid removed (mL), method of post-procedure chest imaging, absence or presence of pneumothorax, pneumothorax size (mm), pneumothorax management measures, and clinical outcomes were recorded. Technical success was defined as successful aspiration of pleural fluid. Post-procedure clinical outcomes included new patient-perceived dyspnea and hypoxia (oxygen saturations < 90% on room air). Costs associated with radiographs were estimated using Medicare and Medicaid fee schedules. Results Mean age was 56.7 ± 15.5 years. Interventional radiology-performed ultrasound-guided thoracentesis was performed on the left (n = 1,531; 50.7%), right (n = 1,477; 48.9%), and bilaterally (n = 14; 0.5%) using 5-French catheters. Technical success was 100% (n = 3,022). Mean volume of 940 ± 550 mL of fluid was removed. Post-procedure imaging was performed in the form of posteroanterior (PA) (2.6%; 78/3,022), anteroposterior (AP) (17.0%; 513/3,022), PA and lateral (77.9%; 2,355/3,022), or PA, lateral, and left lateral decubitus (2.5%; 76/3,022) chest radiographs. Post-procedural pneumothorax was identified in 21 (0.69%) patients. Mean pneumothorax size, measured on chest radiograph as the longest distance from the chest wall to the lung, was 18.8 ± 10.2 mm (range: 5.0–35.0 mm). Of the 21 pneumothoraces, 7 (33.3%) were asymptomatic, resolved spontaneously, and had a mean size of 6.4 ± 2.4 mm. Fourteen pneumothoraces, of mean size 25.0 ± 5.8 mm, required management with a pleural drainage catheter (66.6%). The overall incidence of pneumothorax requiring pleural drainage catheter placement following interventional radiology-performed ultrasound-guided thoracentesis was 0.46% (14/3,022). Of the patients requiring drainage catheter placement, 12/14 (85.7%) and 13/14 (92.9%) had dyspnea and hypoxia, respectively. Potential costs to Medicare and Medicaid, for chest radiographs, in this study, were $27,547 and $10,581, respectively. Conclusion The incidence of clinically significant pneumothorax requiring catheter drainage following interventional radiology-operated ultrasound-guided thoracentesis is exceedingly low (0.46%), and routine post-procedure chest radiographs in asymptomatic patients provide little value. Reserving post-procedure chest radiographs for patients with post-procedure dyspnea or hypoxia will result in more efficient resource utilization and health care cost savings.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1723096ultrasoundthoracentesispneumothoraxchest radiographchest tube placementdrainage catheter placementinterventional radiology |
| spellingShingle | Jacob J. Bundy Anthony N. Hage Ruple Jairath Albert Jiao Vibhor Wadhwa Narendra B. Gutta Ravi N. Srinivasa Joseph J. Gemmete Eric J. Monroe Jeffrey Forris Beecham Chick Limited Clinical Utility of Chest Radiography in Asymptomatic Patients after Interventional Radiology-Performed Ultrasound-Guided Thoracentesis: Analysis of 3,022 Consecutive Patients Journal of Clinical Interventional Radiology ISVIR ultrasound thoracentesis pneumothorax chest radiograph chest tube placement drainage catheter placement interventional radiology |
| title | Limited Clinical Utility of Chest Radiography in Asymptomatic Patients after Interventional Radiology-Performed Ultrasound-Guided Thoracentesis: Analysis of 3,022 Consecutive Patients |
| title_full | Limited Clinical Utility of Chest Radiography in Asymptomatic Patients after Interventional Radiology-Performed Ultrasound-Guided Thoracentesis: Analysis of 3,022 Consecutive Patients |
| title_fullStr | Limited Clinical Utility of Chest Radiography in Asymptomatic Patients after Interventional Radiology-Performed Ultrasound-Guided Thoracentesis: Analysis of 3,022 Consecutive Patients |
| title_full_unstemmed | Limited Clinical Utility of Chest Radiography in Asymptomatic Patients after Interventional Radiology-Performed Ultrasound-Guided Thoracentesis: Analysis of 3,022 Consecutive Patients |
| title_short | Limited Clinical Utility of Chest Radiography in Asymptomatic Patients after Interventional Radiology-Performed Ultrasound-Guided Thoracentesis: Analysis of 3,022 Consecutive Patients |
| title_sort | limited clinical utility of chest radiography in asymptomatic patients after interventional radiology performed ultrasound guided thoracentesis analysis of 3 022 consecutive patients |
| topic | ultrasound thoracentesis pneumothorax chest radiograph chest tube placement drainage catheter placement interventional radiology |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1723096 |
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