Increasing Trends on Intercostal Chest Tube Placement For Hepatic Hydrothorax Despite Negative Impact on Patient Outcomes: A National Inpatient Sample Database Analysis.

Abstract

Background and aims: Hepatic hydrothorax (HH) significantly contribute to morbidity in decompensated cirrhosis. Intercostal chest tube (ICT) insertion is discouraged in HH management. We examined trends in ICT use and impact on outcomes in hospitalized HH patients.

Methods: A retrospective cohort study (10/2015- 12/2019) was conducted using the National Inpatient Sample (NIS) to identify HH hospitalizations among patients with decompensated cirrhosis. Propensity score matching compared patients who received ICT to those who did not. Outcomes included in-hospital mortality (IHM), length of stay (LOS), total charges (TC), and complications.

Results: Among 127,627 cirrhosis hospitalizations, 7843 (6.2%) had HH. Compared to those without HH, these patients had longer LOS, higher TC, and more acute kidney injury (AKI) and sepsis (P<0.001). HH was not associated with increased IHM, but ICT and spontaneous bacterial empyema (SBE) were, each conferring ∼1.5-fold higher odds. ICT was used in 1312 (16.7%) HH cases, with increasing use over time (p=0.037). In a matched cohort of HH hospitalizations (1277 with ICT; 2554 without), ICT use was linked to higher IHM (11.6% vs. 8.5%), longer LOS (14.6 vs. 8.7 days), and greater TC ($196,000 vs. $112,000). Complications were more frequent with ICT: AKI (45% vs. 39%), sepsis (18% vs. 10%), and SBE (12.5% vs. 2%) (P<0.001). ICT use was associated with 44% higher odds of IHM, OR (95% CI): 1.44 (1.15-1.81).

Conclusion: HH occurs in 6.2% of cirrhosis hospitalizations, with one of six receiving ICT. ICT use is increasing despite poorer outcomes and greater resource utilization. Studies targeted toward better patient selection as well as provider education are needed to mitigate ICT use in HH.