Abstract：
BACKGROUND: Malignant pleural effusion (MPE) is a common cancer complication. Clinical and economic implications of different recurrent MPE treatment pathways have not been evaluated fully.
OBJECTIVE: What clinical outcomes, complications, health care resource use, and costs are associated with various rapidly recurrent MPE treatment pathways?
METHODS: This retrospective cohort study using Surveillance, Epidemiology and End Results Medicare data (2011-2015) included patients 66 to 90 years of age with rapidly recurrent MPE. Rapid recurrence was defined as receipt of a second pleural procedure within 14 days of the first thoracentesis, including nondefinitive repeated thoracentesis or a definitive treatment option including chest tube, indwelling pleural catheter (IPC), or thoracoscopy.
RESULTS: Among 8,378 patients with MPE, 3,090 patients (36.9%) had rapidly recurrent MPE (mean ± SD age, 75.9 ± 6.6 years; 45.6% male; primary cancer, 62.9% lung and 37.1% other). Second pleural procedures were nondefinitive thoracentesis (62.3%), chest tube (17.1%), IPC (13.2%), or thoracoscopy (7.4%). A third pleural procedure was required more frequently if the second pleural procedure was nondefinitive thoracentesis vs chest tube placement, IPC placement, or thoracoscopy (70.3% vs 44.1% vs 17.9% vs 14.4%, respectively). The mean number of subsequent pleural procedures over the patient\'s lifetime varied significantly among the procedures (1.74, 0.82, 0.31, and 0.22 procedures for patients receiving thoracentesis, chest tube, IPC, and thoracoscopy, respectively; P < .05). Average total costs after the second pleural procedure to death adjusted for age at primary cancer diagnosis, race, year of second pleural procedure, Charlson comorbidity index, cancer stage at primary diagnosis, and time from primary cancer diagnosis to diagnostic thoracentesis were lower with IPC ($37,443; P < .0001) or chest tube placement ($40,627; P = .004) vs thoracentesis ($47,711). Patients receiving thoracoscopy ($45,386; P = .5) incurred similar costs as patients receiving thoracentesis.
CONCLUSIONS: Early definitive treatment was associated with fewer subsequent procedures and lower costs in patients with rapidly recurrent MPE.
OBJECTIVE: What clinical outcomes, complications, health care resource use, and costs are associated with various rapidly recurrent MPE treatment pathways?
METHODS: This retrospective cohort study using Surveillance, Epidemiology and End Results Medicare data (2011-2015) included patients 66 to 90 years of age with rapidly recurrent MPE. Rapid recurrence was defined as receipt of a second pleural procedure within 14 days of the first thoracentesis, including nondefinitive repeated thoracentesis or a definitive treatment option including chest tube, indwelling pleural catheter (IPC), or thoracoscopy.
RESULTS: Among 8,378 patients with MPE, 3,090 patients (36.9%) had rapidly recurrent MPE (mean ± SD age, 75.9 ± 6.6 years; 45.6% male; primary cancer, 62.9% lung and 37.1% other). Second pleural procedures were nondefinitive thoracentesis (62.3%), chest tube (17.1%), IPC (13.2%), or thoracoscopy (7.4%). A third pleural procedure was required more frequently if the second pleural procedure was nondefinitive thoracentesis vs chest tube placement, IPC placement, or thoracoscopy (70.3% vs 44.1% vs 17.9% vs 14.4%, respectively). The mean number of subsequent pleural procedures over the patient\'s lifetime varied significantly among the procedures (1.74, 0.82, 0.31, and 0.22 procedures for patients receiving thoracentesis, chest tube, IPC, and thoracoscopy, respectively; P < .05). Average total costs after the second pleural procedure to death adjusted for age at primary cancer diagnosis, race, year of second pleural procedure, Charlson comorbidity index, cancer stage at primary diagnosis, and time from primary cancer diagnosis to diagnostic thoracentesis were lower with IPC ($37,443; P < .0001) or chest tube placement ($40,627; P = .004) vs thoracentesis ($47,711). Patients receiving thoracoscopy ($45,386; P = .5) incurred similar costs as patients receiving thoracentesis.
CONCLUSIONS: Early definitive treatment was associated with fewer subsequent procedures and lower costs in patients with rapidly recurrent MPE.
摘要：
背景：恶性胸腔积液（MPE）是一种常见的癌症并发症。不同复发性MPE治疗途径的临床和经济意义尚未得到充分评估。
目的：什么临床结果，并发症,医疗保健资源使用，和费用与各种快速复发的MPE治疗途径相关？
方法：这项使用监测的回顾性队列研究，流行病学和最终结果医疗保险数据(2011-2015)包括66-90岁的快速复发MPE患者。快速复发定义为在第一次胸腔穿刺术后14天内接受第二次胸膜手术，包括非确定性重复胸腔穿刺术。或确定的治疗选择，包括胸管，留置胸膜导管(IPC),或胸腔镜检查。
结果：在8,378例MPE患者中，3,090（36.9%）患有快速复发的MPE（平均[SD]年龄75.9[6.6]，45.6%男性,原发性肺癌占62.9%，其他占37.1%）。第二次胸膜手术是非确定性胸腔穿刺术（62.3％），胸管(17.1%),IPC（13.2%），或胸腔镜（7.4%）。如果第二次胸膜手术是非确定性胸腔穿刺术与胸管,IPC,或胸腔镜(70.3%vs.44.1%vs.17.9%与14.4%,分别)。在患者的一生中，随后的胸膜手术的平均次数在手术中差异很大（对于接受胸腔穿刺术的患者，为1.74、0.82、0.31和0.22，胸管,IPC,和胸腔镜检查，分别；P<0.05）。第二次胸膜手术后死亡的平均总费用根据原发性癌症诊断时的年龄进行调整，种族,第二次胸膜手术的年份，Charlson合并症指数，初诊时的癌症阶段，IPC（$37,443;P<.0001）或胸管（$40,627;P=.004）与从原发性癌症诊断到诊断性胸腔穿刺术的时间更低。胸腔穿刺术（$47,711）。接受胸腔镜检查的患者（$45,386;P=5）的费用与接受胸腔穿刺术的患者相似。
结论：在快速复发的MPE中，早期确定性治疗与较少的后续手术和较低的成本相关。
目的：什么临床结果，并发症,医疗保健资源使用，和费用与各种快速复发的MPE治疗途径相关？
方法：这项使用监测的回顾性队列研究，流行病学和最终结果医疗保险数据(2011-2015)包括66-90岁的快速复发MPE患者。快速复发定义为在第一次胸腔穿刺术后14天内接受第二次胸膜手术，包括非确定性重复胸腔穿刺术。或确定的治疗选择，包括胸管，留置胸膜导管(IPC),或胸腔镜检查。
结果：在8,378例MPE患者中，3,090（36.9%）患有快速复发的MPE（平均[SD]年龄75.9[6.6]，45.6%男性,原发性肺癌占62.9%，其他占37.1%）。第二次胸膜手术是非确定性胸腔穿刺术（62.3％），胸管(17.1%),IPC（13.2%），或胸腔镜（7.4%）。如果第二次胸膜手术是非确定性胸腔穿刺术与胸管,IPC,或胸腔镜(70.3%vs.44.1%vs.17.9%与14.4%,分别)。在患者的一生中，随后的胸膜手术的平均次数在手术中差异很大（对于接受胸腔穿刺术的患者，为1.74、0.82、0.31和0.22，胸管,IPC,和胸腔镜检查，分别；P<0.05）。第二次胸膜手术后死亡的平均总费用根据原发性癌症诊断时的年龄进行调整，种族,第二次胸膜手术的年份，Charlson合并症指数，初诊时的癌症阶段，IPC（$37,443;P<.0001）或胸管（$40,627;P=.004）与从原发性癌症诊断到诊断性胸腔穿刺术的时间更低。胸腔穿刺术（$47,711）。接受胸腔镜检查的患者（$45,386;P=5）的费用与接受胸腔穿刺术的患者相似。
结论：在快速复发的MPE中，早期确定性治疗与较少的后续手术和较低的成本相关。
