Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, United States of America.
PLoS One. 2022 Apr 28;17(4):e0267152. doi: 10.1371/journal.pone.0267152. eCollection 2022.
While institutional series have sought to define the optimal strategy for drainage of pericardial effusions, large-scale comparisons remain lacking. Using a nationally representative sample, the present study examined clinical and financial outcomes following pericardiocentesis (PC) and surgical drainage (SD) in patients admitted for pericardial effusion and tamponade.
Adults undergoing PC or SD within 2 days of admission for non-surgically related pericardial effusion or tamponade were identified in the 2016-2019 Nationwide Readmissions Database. Multivariable logistic and linear models were developed to evaluate the association between intervention type and outcomes. The primary outcome of interest was mortality while secondary endpoints included reintervention, periprocedural complications, hospital length of stay (LOS), hospitalization costs and 30-day non-elective readmission.
Of an estimated 44,637 records meeting inclusion criteria, 28,862 (64.7%) underwent PC while the remainder underwent SD for initial management of pericardial effusion or tamponade. PC was associated with significantly increased odds of in-hospital mortality, reintervention and 30-day readmission relative to SD. PC was also associated with greater odds of cardiac complications but lower odds of infection, respiratory failure and blood transfusions compared to SD. Although PC was associated with shorter index hospital length of stay and costs, the two strategies yielded similar 30-day cumulative costs.
Management of pericardial effusion with PC is associated with greater odds of mortality, reintervention and 30-day readmission but similar 30-day cumulative costs compared to SD. In the setting of adequate hospital capability and operator expertise, SD is a reasonable initial treatment strategy for pericardial effusion.
虽然机构系列研究试图确定治疗心包积液的最佳引流策略，但仍缺乏大规模的比较。本研究使用全国代表性样本，考察了因心包积液和填塞而住院的患者行心包穿刺术（PC）和外科引流（SD）后的临床和财务结局。
在 2016 年至 2019 年全国再入院数据库中，确定了在因非手术相关心包积液或填塞住院后 2 天内行 PC 或 SD 的成年人。采用多变量逻辑和线性模型评估干预类型与结局之间的关联。主要研究终点为死亡率，次要终点包括再干预、围手术期并发症、住院时间（LOS）、住院费用和 30 天非择期再入院。
在估计符合纳入标准的 44637 条记录中，28862 条（64.7%）行 PC，其余患者行 SD 作为心包积液或填塞的初始治疗。与 SD 相比，PC 与院内死亡率、再干预和 30 天再入院的几率显著增加相关。与 SD 相比，PC 还与更高的心脏并发症几率相关，但与感染、呼吸衰竭和输血的几率较低相关。尽管 PC 与指数住院时间和费用缩短相关，但两种策略在 30 天的累积费用相似。
与 SD 相比，PC 治疗心包积液与更高的死亡率、再干预和 30 天再入院几率相关，但与 30 天的累积费用相似。在具备充分医院能力和操作人员专业知识的情况下，SD 是心包积液的合理初始治疗策略。
