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

Abstract

Introduction: Hepatic hydrothorax (HH) significantly contributes 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 (October 2015-December 2019) was conducted using the National Inpatient Sample to identify HH hospitalizations among patients with decompensated cirrhosis. Propensity score matching compared patients who received ICT with 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, 7,843 (6.2%) had HH. Compared with those without HH, these patients had longer LOS, higher TC, and more acute kidney injury and sepsis ( P < 0.001). HH was not associated with increased IHM, but ICT and spontaneous bacterial empyema were, each conferring ∼1.5-fold higher odds. ICT was used in 1,312 HH cases (16.7%), with increasing use over time ( P = 0.037). In a matched cohort of HH hospitalizations (1,277 with ICT; 2,554 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: acute kidney injury (45% vs 39%), sepsis (18% vs 10%), and spontaneous bacterial empyema (12.5% vs 2%) ( P < 0.001). ICT use was associated with 44% higher odds of IHM, OR (95% confidence intervals): 1.44 (1.15-1.81).

Discussion: HH occurs in 6.2% of cirrhosis hospitalizations, with 1 of 6 receiving ICT. ICT use is increasing despite poorer outcomes and greater resource utilization. Studies targeted toward better patient selection and provider education are needed to mitigate ICT use in HH.