Outpatient management of pneumothorax after fine-needle aspiration: economic advantages for the hospital and patient

Abstract

Purpose: To evaluate the efficacy and cost savings of outpatient management of post-fine-needle aspiration (FNA) pneumothoraces with small-caliber catheters.

Materials and methods: The authors retrospectively reviewed the medical and hospital billing records from 74 patients with enlarging or symptomatic post-FNA pneumothoraces treated with a small-caliber catheter. Forty patients (54%) were treated on an outpatient basis, 17 patients (23%) were treated on an inpatient basis, and 17 patients (23%) were monitored overnight in the emergency department. Only one patient initially treated on an outpatient basis had to return for inpatient observation and suction because of a persistent pneumothorax.

Results: The catheters remained in place overnight in 46 patients (33 outpatients, 12 emergency department patients, and one inpatient). The number of days the catheters were left in place was prolonged (range, 2-13 days) in seven outpatients, five emergency department patients, and 16 inpatients. The mean cost per patient for lung biopsy and pneumothorax management was as follows: outpatients, $1,689; emergency department patients, $2,403; and inpatients, $3,950. Elevated inpatient expense was related to the number of chest radiographs obtained, pharmacy charges, and room charges. Cost elevation for emergency department patients was related to pharmacy charges and the cost of overnight observation.

Conclusion: Outpatient management of simple pneumothoraces with placement of small-caliber catheters attached to one-way chest drain valves proved to be safe, efficient, and economical.