Impact of a specialised pleural medicine unit in the management of pleural infection.

Abstract

Background: Managing pleural infection can be complex and costly and demonstrates considerable healthcare utlilisation.

Aims: To describe the influence of a specialised pleural medicine unit (SPMU) on outcomes for people with pleural infection at a metropolitan health service.

Methods: Administrative data were used to identify cases of pleural infection, which were classified into (i) empyema, (ii) parapneumonic effusion and (iii) clinical suspicion of pleural infection. Two cohorts were compared: Period 1 (pre-SPMU from January 2016 to August 2018) and Period2 (post-SPMU from August 2018 to October 2020).

Results: In total, 213 individuals were managed for pleural infection across the two time periods (Period 1 (n = 108), Period 2 (n = 105)). Intrapleural therapy (IPT) was utilised more frequently in Period 2 (0% vs 15.2%, P = <0,001) with earlier intervention (76.8 vs 47.5 h, P = 0.17). These observations were associated with a significant reduction in surgical intervention rate (25.9% vs 7.6%, P < 0.001) without any significant difference in the median length of stay from diagnosis to discharge (9.4 days (interquartile range (IQR) 5.1-15.9) days in Period 1 vs 7.3 days (IQR 4.3-13.1 days) in Period 2 (P = 0.13)). Outcomes at 90 days (mortality and pleural-related readmissions) were not different between the two cohorts. In a subgroup analysis comparing patients who received advanced therapies (either surgery or IPT), there was shorter hospitalisation time (15.8 vs 12.5 days, P = 0.084) and lower inpatient costs ($79 663.9 vs $56 513.6, P = 0.016) during Period 2 without a rise in adverse events or mortality.

Conclusion: The introduction of an SPMU was associated with increased utilisation of IPT and a reduction in surgical interventions for the management of pleural infections.