THE MANAGEMENT OF MALIGNANT PLEURAL EFFUSIONS. THE IMPACT OF INDWELLING PLEURAL CATHETER VERSUS PLEURODESIS ON PATIENT-REPORTED OUTCOMES, NEED FOR RE-INTERVENTION, COMPLICATIONS, AND LENGTH OF STAY.

Abstract

Background: Chemical pleurodesis and indwelling pleural catheters (IPCs) are the two most common treatments for malignant pleural effusions (MPEs). Previous systematic reviews inadequately address patient-reported outcomes (PROs). Methods: A systematic review and meta-analysis was performed comparing IPC and pleurodesis for MPEs. Primary outcomes were patient-reported outcomes (PROs). Secondary outcomes included repeat pleural intervention, complication rates, and length of stay (LOS). PROs were analyzed using multiple methods based on established minimally important differences. Other outcomes were analyzed using standard methodology. Results: For all PROs, there was only trivial to very small differences at specific timepoints. IPCs resulted in decreased repeat pleural intervention and decreased LOS but increased overall, infectious, and serious complications and tumour seeding. Conclusions: Given a lack of difference in PROs, the decreased LOS and risk of repeat pleural intervention with IPC needs to be weighed against the increased risk of complications based on patient values and preferences.