Chest
Patient Safety ForumUltrasound Guidance Decreases Complications and Improves the Cost of Care Among Patients Undergoing Thoracentesis and Paracentesis
Section snippets
Data Source
Analyses were conducted using Premier's Perspective Comparative Database, a nationally representative database of claims reported from more than 600 US hospitals and 2.5 billion deidentified patient daily service records. The database contains basic patient characteristics, diagnoses and procedures coded according to International Statistical Classification of Diseases and Related Health Problems, Ninth Revision (ICD-9) and Current Procedural Terminology, Fourth Edition (CPT) codes, and a
Thoracentesis
We initially identified 98,727 patients who had a thoracentesis. The most common exclusions were patients who had mechanical ventilation (18.6%), trauma (18.2%), and thoracic surgery (10.6%). After exclusions, there were 61,261 patients who had a thoracentesis, including 26,838 (44%) who had ultrasound guidance.
Patients with and without ultrasound guidance during thoracentesis were similar regarding age, sex, and insurance provider, but more patients without ultrasound guidance came from
Discussion
In this large population of hospitalized patients, ultrasound guidance was associated with a 19% reduction of the risk of pneumothorax from thoracentesis and a 68% reduction of the risk of bleeding complications from paracentesis. Patients with ultrasound-guided procedures had lower hospitalization costs and LOS. These lower rates of use may be attributed, at least in part, to lower rates of adverse events, which we found to substantially increase costs and LOS in both patient cohorts.
Acknowledgments
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Ms Mercaldi and Dr Lanes are employees of United BioSource Corporation, which was contracted by SonoSite to conduct this study.
Role of sponsors: The sponsor reviewed and commented on the protocol and manuscript.
Other contributions: We thank Diku Mandavia, MD, who is an employee of SonoSite, for providing clinical perspective and expertise in the field of ultrasonography.
References (24)
- et al.
Acute hemoperitoneum after large-volume paracentesis
Gastroenterology
(1997) - et al.
Reducing iatrogenic risk in thoracentesis: establishing best practice via experiential training in a zero-risk environment
Chest
(2009) - et al.
Ultrasound-guided thoracentesis: is it a safer method?
Chest
(2003) - et al.
Pathophysiology of pneumothorax following ultrasound-guided thoracentesis
Chest
(2006) - et al.
Lower risk and higher yield for thoracentesis when performed by experienced operators
Chest
(1993) - et al.
The urgent need to improve health care quality
JAMA
(1998) - et al.
The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II
N Engl J Med
(1991) - et al.
Impact of procedure-related complications on patient outcome on a general medicine service
J Gen Intern Med
(1994) Hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and FY 2012 rates; Hospitals' FTE resident caps for graduate medical education payment. US Government Printing Office website
Making health care safer: a critical analysis of patient safety practices
Evid Rep Technol Assess (Summ)
Patient Protection and Affordable Care Act. US Government Printing Office website
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Funding/Support: This study was funded by SonoSite, Inc.
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