Rising pericardial effusion burden and procedural shifts in the US

Abstract Pericardial effusions range from incidental to life-threatening tamponade. Treatment targets underlying causes, with pericardiocentesis or pericardial window used in hemodynamic compromise or diagnostic uncertainty. Intervention is recommended for tamponade or suspected bacterial or neoplastic etiology; watchful waiting is safe for chronic idiopathic cases, with anti-inflammatory therapy for pericarditis-associated effusions. This study examines U. S. trends in pericardial effusion, drainage procedures, and their impact on mortality, length of stay, and hospital charges from 2018 to 2022. Methods: Using the National Inpatient Sample (NIS), a large-scale survey dataset of US hospitalizations, we analyzed the incidence of pericardial effusion and the proportion of patients undergoing pericardiocentesis or pericardial window procedures annually. Logistic regression models, both crude and adjusted for covariates were used to assess mortality odds ratios. Mean length of stay (LOS) and total hospital charges were compared across procedure groups. Results: 990, 964 admissions with pericardial effusions were identified with 86, 145 patients receiving pericardiocentesis and 56, 156 receiving a pericardial window. The number of hospitalization with pericardial effusions increased from 790, 960 in 2018 to 1, 212, 840 in 2022. Among patients with pericardial effusion, pericardiocentesis rates remained stable (8. 3%–9. 0%), while pericardial window procedures decreased from 6. 7% in 2018 to 4. 6% in 2022. Crude mortality odds were higher for pericardiocentesis (OR 1. 38, 95% CI 1. 31–1. 45) but lower for pericardial window (OR 0. 89, 95% CI 0. 83–0. 95) compared to no drainage. Adjusted models confirmed increased mortality risk with pericardiocentesis (OR 1. 33, 95% CI 1. 26–1. 41) and reduced risk with pericardial window (OR 0. 87, 95% CI 0. 81–0. 94). Patients undergoing pericardiocentesis or pericardial window had longer LOS (9. 87 vs. 11. 64 days) and higher charges (182, 523 vs. 223, 028) compared to those without drainage (9. 02 days, 144, 778). Conclusion: Pericardial effusion hospitalizations increased substantially from 2018 to 2022, likely due to enhanced echocardiographic detection and an aging population with more malignancy and renal disease. Pericardiocentesis, used urgently in acutely unstable patients with tamponade, was associated with higher mortality and greater resource use than no drainage, reflecting selection of the sickest cases. In contrast, pericardial window, a planned surgical approach for recurrent or malignant effusions, showed a mortality benefit but required longer stays and higher costs due to operative and postoperative demands; its declining frequency suggests growing preference for less invasive strategies.