title: Indwelling pleural catheters reduce inpatient days over pleurodesis for malignant pleural effusion.
abstract: BACKGROUND
  Patients with malignant pleural effusion (MPE) have limited prognoses. They require long-lasting symptom relief with minimal hospitalization. Indwelling pleural catheters (IPCs) and talc pleurodesis are approved treatments for MPE. Establishing the implications of IPC and talc pleurodesis on subsequent hospital stay will influence patient choice of treatment. Therefore, our objective was to compare patients with MPE treated with IPC vs pleurodesis in terms of hospital bed days (from procedure to death or end of follow-up) and safety.
  
  
  METHODS
  In this prospective, 12-month, multicenter study, patients with MPE were treated with IPC or talc pleurodesis, based on patient choice. Key end points were hospital bed days from procedure to death (total and effusion-related). Complications, including infection and protein depletion, were monitored longitudinally.
  
  
  RESULTS
  One hundred sixty patients with MPE were recruited, and 65 required definitive fluid control; 34 chose IPCs and 31 pleurodesis. Total hospital bed days (from any causes) were significantly fewer in patients with IPCs (median, 6.5 days; interquartile range [IQR] = 3.75-13.0 vs pleurodesis, mean, 18.0; IQR, 8.0-26.0; P = .002). Effusion-related hospital bed days were significantly fewer with IPCs (median, 3.0 days; IQR, 1.8-8.3 vs pleurodesis, median, 10.0 days; IQR, 6.0-18.0; P < .001). Patients with IPCs spent significantly fewer of their remaining days of life in hospital (8.0% vs 11.2%, P < .001, χ(2) = 28.25). Fewer patients with IPCs required further pleural procedures (13.5% vs 32.3% in pleurodesis group). There was no difference in rates of pleural infection (P = .68) and protein (P = .65) or albumin loss (P = .22). More patients treated with IPC reported immediate (within 7 days) improvements in quality of life and dyspnea.
  
  
  CONCLUSIONS
  Patients treated with IPCs required significantly fewer days in hospital and fewer additional pleural procedures than those who received pleurodesis. Safety profiles and symptom control were comparable.
authors.affiliation: Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth; Centre for Asthma, Allergy, and Respiratory Research, University of Western Australia, Perth; School of Medicine and Pharmacology, University of Western Australia, Perth.
authors.forename: Edward T H
authors.initials: ETH
authors.lastname: Fysh
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Perth; Department of Respiratory Medicine, Royal Perth Hospital, Perth.
authors.forename: Grant W
authors.initials: GW
authors.lastname: Waterer
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Perth; Department of Respiratory Medicine, Fremantle Hospital, Fremantle, WA, Australia.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Kendall
authors.affiliation: Department of Respiratory Medicine, Fremantle Hospital, Fremantle, WA, Australia.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Bremner
authors.affiliation: Department of Respiratory Medicine, Fremantle Hospital, Fremantle, WA, Australia.
authors.forename: Sharifa
authors.initials: S
authors.lastname: Dina
authors.affiliation: School of Population Health, University of Western Australia, Perth.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Geelhoed
authors.affiliation: Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth.
authors.forename: Kate
authors.initials: K
authors.lastname: McCarney
authors.affiliation: Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth.
authors.forename: Sue
authors.initials: S
authors.lastname: Morey
authors.affiliation: Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth; School of Medicine and Pharmacology, University of Western Australia, Perth.
authors.forename: Michael
authors.initials: M
authors.lastname: Millward
authors.affiliation: Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth; School of Population Health, University of Western Australia, Perth.
authors.forename: A W Bill
authors.initials: AWB
authors.lastname: Musk
authors.affiliation: Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth; Centre for Asthma, Allergy, and Respiratory Research, University of Western Australia, Perth; School of Medicine and Pharmacology, University of Western Australia, Perth. Electronic address: gary.lee@uwa.edu.au.
authors.forename: Y C Gary
authors.initials: YCG
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling; D004322:Drainage / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D057240:Patient Preference; D010865:Pilot Projects; D016066:Pleural Effusion, Malignant / Q000150:complications / Q000473:pathology / Q000628:therapy*; D018700:Pleurodesis; D011446:Prospective Studies; D013627:Talc / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D013627:Talc