Timing of Pericardiocentesis and In-Hospital Outcomes in Cancer Patients With Cardiac Tamponade: A Retrospective Cross-Sectional National Inpatient Sample Study

Timing of Pericardiocentesis and In-Hospital Outcomes in Cancer Patients With Cardiac Tamponade: A Retrospective Cross-Sectional National Inpatient Sample Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Timing of Pericardiocentesis and In-Hospital Outcomes in Cancer Patients With Cardiac Tamponade: A Retrospective Cross-Sectional National Inpatient Sample Study Chanokporn Puchongmart, Nithila Sivakumar, Panat Yanpiset, Natnicha Leelaviwat, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9098532/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Cardiac tamponade is a life-threatening complication in patients with cancer and often prompts urgent pericardial drainage. Contemporary data on how the timing of pericardiocentesis relates to outcomes in this population remain limited. Methods We performed a retrospective cross-sectional study of the U.S. National Inpatient Sample from 2016 to 2022. Adult hospitalizations with cardiac tamponade and a concomitant cancer diagnosis that underwent pericardiocentesis or pericardial drainage were included. Timing was categorized as early drainage (hospital day 0) or delayed drainage (hospital day ≥ 1). The primary outcome was in-hospital mortality. Secondary outcomes were length of stay and inflation-adjusted total hospital charges. Survey-weighted analyses generated national estimates, and multivariable survey-weighted logistic regression was used to estimate adjusted odds ratios for mortality. Results We identified 2255 cancer-related hospitalizations with cardiac tamponade undergoing pericardiocentesis or pericardial drainage; 1140 (50.6%) received early drainage and 1115 (49.4%) received delayed drainage. Respiratory cancers were the most common malignancy group (28.3%), followed by breast cancer (8.2%). Delayed drainage was associated with higher unadjusted in-hospital mortality than early drainage (14.8% vs 8.8%; p = 0.052), a longer mean length of stay (10.12 vs 7.04 days; p < 0.01), and higher mean inflation-adjusted hospital charges (174178 vs 113922.9; p < 0.01). After adjustment, delayed drainage remained independently associated with increased odds of in-hospital death (adjusted odds ratio 2.21; 95% confidence interval 1.11–4.41; p = 0.025). Conclusions Among cancer-related hospitalizations complicated by cardiac tamponade, delayed pericardiocentesis was independently associated with higher in-hospital mortality. These findings support timely drainage and justify prospective studies to identify workflow barriers and improve acute cardio-oncology care. Trial registration: Not applicable. cardiac tamponade pericardiocentesis cancer cardio-oncology inpatient outcomes Figures Figure 1 Figure 2 Background Cardiac tamponade is a time-critical hemodynamic emergency in which rising intrapericardial pressure restricts ventricular filling, reduces stroke volume and cardiac output, and can rapidly progress to shock and death without prompt intervention ( 1 ). Among clinically significant causes of pericardial effusion and tamponade, cancer remains an important driver, through metastatic involvement, direct tumor extension, treatment-related injury, or coexisting systemic illness ( 1 – 8 ). Respiratory malignancies are frequently represented in malignant pericardial disease cohorts, and breast cancer is also commonly encountered ( 4 – 8 ). Pericardiocentesis is the definitive and potentially reversible treatment for tamponade physiology. Although current guidance emphasizes urgent decompression, real-world drainage timing may still be influenced by diagnostic delay, hemodynamic uncertainty, thrombocytopenia or coagulopathy, anticoagulation status, consultant availability, and procedural access ( 9 – 13 ). In cancer populations, these competing clinical considerations may be especially relevant because advanced malignancy, bleeding risk, and goals-of-care discussions often coexist at presentation. Evidence evaluating the relationship between drainage timing and in-hospital outcomes in cancer patients with cardiac tamponade remains limited. We therefore used the U.S. National Inpatient Sample (NIS) to examine cancer-related hospitalizations complicated by cardiac tamponade in which pericardiocentesis or pericardial drainage was performed, and to compare outcomes between early drainage on hospital day 0 and delayed drainage on hospital day 1 or later. Methods Study design and data source We performed a retrospective cross-sectional study using the Healthcare Cost and Utilization Project (HCUP) NIS from 2016 through 2022. The NIS is a nationally representative, all-payer inpatient discharge database. Diagnoses are coded using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), and inpatient procedures are coded using the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS). The unit of analysis was the hospitalization. Study population We included adult hospitalizations (age ≥ 18 years) with cardiac tamponade recorded as a principal or secondary diagnosis (ICD-10-CM I31.4) and a concomitant cancer diagnosis identified using HCUP Clinical Classifications Software Refined cancer categories in any diagnosis field. We required that pericardiocentesis or pericardial drainage be performed during the same admission, identified by ICD-10-PCS pericardial cavity drainage codes in any procedure field: 0W9D30Z, 0W9D3ZX, 0W9D3ZZ, 0W9D40Z, 0W9D4ZX, and 0W9D4ZZ. Admissions classified as non-melanoma skin cancer were excluded. Exposure and outcomes Pericardiocentesis timing was determined using the NIS days-from-admission-to-procedure variable and defined according to the earliest qualifying pericardial drainage procedure day across all listed procedures. Early drainage was defined as hospital day 0, and delayed drainage as hospital day 1 or later. The primary outcome was in-hospital mortality. Secondary outcomes were hospital length of stay and total hospital charges. Charges were inflation-adjusted using Bureau of Labor Statistics price indices. Comorbidities were identified using HCUP Elixhauser comorbidity software. Statistical analysis All analyses used survey-weighted methods to account for the complex sampling design of the NIS and to generate national estimates. Continuous variables were summarized as survey-weighted means with standard errors, and categorical variables as survey-weighted percentages. In-hospital mortality was compared between drainage-timing groups using survey-weighted cross-tabulations. Length of stay and inflation-adjusted total charges were compared using survey-weighted regression methods. We then fitted a multivariable survey-weighted logistic regression model with in-hospital mortality as the dependent variable. Drainage timing was the primary exposure, and covariates included age, sex, race or ethnicity, hypertension, diabetes mellitus, and selected clinically relevant Elixhauser comorbidity indicators. Results are reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). A two-sided p value < 0.05 was considered statistically significant. Analyses were performed using Stata/MP 18.0 (StataCorp, College Station, TX, USA). Results We identified 2255 cancer-related hospitalizations complicated by cardiac tamponade in which pericardiocentesis or pericardial drainage was performed. Of these, 1140 (50.6%) underwent early drainage on hospital day 0 and 1115 (49.4%) underwent delayed drainage on hospital day 1 or later. Selected baseline characteristics are shown in Table 1 , and the full baseline table is provided in Additional file 1. The mean age was 59.25 years in the early-drainage group and 56.66 years in the delayed-drainage group (p = 0.07). Female sex distribution was similar between groups (49.56% vs 50.90%; p = 0.775). Overall race or ethnicity distribution did not differ significantly (p = 0.157). Diabetes mellitus was more common in the early-drainage group (22.81% vs 14.35%; p = 0.016), whereas most other selected comorbidities were similar between groups. Table 1 Selected baseline characteristics by drainage timing Values are survey-weighted means (SE) or percentages. The full baseline characteristics table is provided in Additional file 1. Characteristic Early drainage (day 0) (N = 1140) Delayed drainage (day ≥ 1) (N = 1115) p value Age, mean (SE) 59.25 (0.98) 56.66 (1.05) 0.07 Female sex 49.56% 50.90% 0.775 Race or ethnicity 0.157 White 56.95% 59.45% African American 18.83% 13.36% Hispanic 14.35% 11.06% Asian or Pacific Islander 5.38% 6.91% Native American 0.00% 0.92% Other 4.48% 8.29% Hypertension 50.44% 43.50% 0.140 Diabetes mellitus 22.81% 14.35% 0.016 Congestive heart failure 19.74% 17.94% 0.644 Cardiac arrhythmias 42.11% 43.50% 0.747 Valvular heart disease 6.58% 2.69% 0.051 Pulmonary circulation disorder 10.96% 8.52% 0.384 Renal failure 12.28% 10.31% 0.522 Liver disease 8.33% 8.97% 0.811 Coagulopathy 12.28% 13.45% 0.708 Obesity 7.46% 11.21% 0.164 Metastatic cancer 67.98% 60.54% 0.093 Measures of clinical acuity were also similar between groups. Shock was observed more often in the early-drainage group than in the delayed-drainage group (17.5% vs 11.7%; p = 0.07), whereas respiratory failure occurred at comparable frequencies (22.4% vs 24.2%; p = 0.64). The distribution of cancer subtypes is presented in Fig. 1 . Respiratory malignancies comprised the largest subgroup (28.3%), followed by breast cancer (8.2%). The full cancer subtype distribution is provided in Additional file 1. In-hospital outcomes are summarized in Table 2 . Delayed drainage was associated with higher unadjusted in-hospital mortality than early drainage (14.80% vs 8.77%; p = 0.052). Delayed drainage was also associated with a longer mean length of stay (10.12 vs 7.04 days; p < 0.01) and higher mean inflation-adjusted total hospital charges (174178 vs 113922.9; p < 0.01). Table 2 In-hospital outcomes by drainage timing Values are survey-weighted percentages or means (SE). Hospital charges were inflation-adjusted. Outcome Early drainage (day 0) Delayed drainage (day ≥ 1) p value In-hospital mortality 8.77% 14.80% 0.052 Length of stay, mean (SE) 7.04 (0.41) 10.12 (0.74) < 0.01 Inflation-adjusted charges, mean (SE) 113922.9 (10415) 174178 (20213) < 0.01 Table 3 and Fig. 2 show the adjusted analysis for in-hospital mortality. Delayed pericardiocentesis remained independently associated with increased odds of in-hospital death (aOR 2.21; 95% CI 1.11–4.41; p = 0.025). Coagulopathy (aOR 3.70; 95% CI 1.62–8.46; p = 0.002), cardiac arrhythmias (aOR 2.03; 95% CI 1.01–4.09; p = 0.048), and African American race compared with White race (aOR 4.13; 95% CI 1.93–8.86; p < 0.001) were also associated with higher in-hospital mortality. Age, sex, hypertension, congestive heart failure, valvular heart disease, pulmonary circulation disorders, renal failure, liver disease, and obesity were not significantly associated with mortality in the final model. Table 3 Adjusted odds of in-hospital mortality Multivariable survey-weighted logistic regression with in-hospital mortality as the dependent variable. Reference groups were day 0 drainage, male sex, and White race. Variable Adjusted OR 95% CI p value Delayed drainage (day ≥ 1 vs day 0) 2.21 1.11–4.41 0.025 Age 1.01 0.98–1.04 0.635 Female sex 1.05 0.56–1.95 0.889 African American race (vs White) 4.13 1.93–8.86 < 0.001 Hispanic race (vs White) 1.50 0.59–3.78 0.390 Other race (vs White) 1.11 0.27–4.60 0.886 Hypertension 0.46 0.21–1.02 0.056 Diabetes mellitus 2.34 0.98–5.59 0.056 Congestive heart failure 1.12 0.52–2.43 0.771 Cardiac arrhythmias 2.03 1.01–4.09 0.048 Valvular heart disease 0.66 0.16–2.65 0.558 Pulmonary circulation disorder 0.49 0.14–1.72 0.264 Renal failure 0.83 0.35–1.98 0.676 Liver disease 2.21 0.86–5.71 0.100 Coagulopathy 3.70 1.62–8.46 0.002 Obesity 0.54 0.14–2.15 0.385 Discussion In this nationally representative analysis of cancer-related hospitalizations complicated by cardiac tamponade, delayed pericardiocentesis was associated with worse in-hospital outcomes. Compared with drainage performed on hospital day 0, delayed drainage was associated with higher in-hospital mortality, longer hospitalization, and greater inflation-adjusted hospital charges. After multivariable adjustment, delayed drainage remained independently associated with more than twofold higher odds of in-hospital death. These findings support the clinical principle that timely decompression is central to the management of tamponade in cardio-oncology practice ( 9 , 10 ). Our results are clinically plausible and align with existing guidance that prioritizes urgent drainage while allowing only brief deferral in carefully selected, closely monitored patients ( 10 ). In real-world oncology populations, however, same-day drainage may not always be achieved because of delayed recognition, the need for confirmatory imaging, thrombocytopenia or coagulopathy, anticoagulation reversal, limited procedural availability, or competing oncologic decision-making ( 11 – 16 ). The observation that only about half of hospitalizations underwent drainage on day 0 suggests a potentially modifiable systems-level gap in care delivery. Similar improvements in other time-sensitive cardiovascular emergencies have been achieved through standardized workflows and quality-improvement initiatives ( 18 – 20 ). The cancer subtype distribution in our cohort also supports the face validity of the study population, with respiratory malignancies and breast cancer representing the most common groups, consistent with prior reports of malignant pericardial disease ( 1 , 4 – 8 ). In the adjusted model, coagulopathy and cardiac arrhythmias were also associated with higher in-hospital mortality, which is clinically plausible in a population characterized by hemodynamic instability, advanced malignancy, and procedure-related bleeding risk. The higher adjusted mortality observed among African American patients warrants further investigation to clarify the potential roles of illness severity, access to timely specialty care, procedural timing, hospital-level factors, and broader structural inequities ( 17 ). This study has several limitations. First, the NIS is an administrative database and lacks detailed clinical information such as vital signs, echocardiographic findings, tamponade severity, laboratory values, cancer stage, treatment status, and goals of care. Second, identification of tamponade, cancer subtype, and pericardial drainage relied on ICD-10 coding and may be subject to misclassification. Third, the timing variable is derived from days from admission to procedure and may be affected by coding practices. Fourth, the database does not provide procedural granularity such as imaging guidance, drainage duration, complications, or recurrence. Finally, because this is an observational study of hospitalizations rather than unique patients, residual confounding is likely and longitudinal outcomes cannot be assessed. Despite these limitations, the large nationally representative sample provides useful real-world insight into a high-acuity cardio-oncology emergency. Conclusions Among cancer-related hospitalizations complicated by cardiac tamponade that underwent pericardiocentesis or pericardial drainage, delayed drainage on hospital day 1 or later was independently associated with higher in-hospital mortality, longer hospitalization, and greater hospital charges. These findings identify a potentially actionable opportunity to improve care for a high-risk population by strengthening inpatient workflows that support earlier recognition and timely drainage. Prospective studies are needed to identify specific causes of delay and evaluate targeted quality-improvement strategies. Abbreviations aOR adjusted odds ratio CI confidence interval HCUP Healthcare Cost and Utilization Project HIPAA Health Insurance Portability and Accountability Act ICD-10-CM International Classification of Diseases,Tenth Revision,Clinical Modification ICD-10-PCS International Classification of Diseases,Tenth Revision,Procedure Coding System LOS length of stay NIS National Inpatient Sample. Declarations Ethics approval and consent to participate This study used de-identified discharge-level data from the HCUP National Inpatient Sample. Institutional review board review and informed consent were not required for this analysis of de-identified data. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding The authors received no specific funding for this work. Author Contribution CP and NS conceived the study. CP, NS, and PY designed the analysis. CP and NS drafted the initial manuscript. CP, NS, PY, NL, DS, TS, TY, and NK contributed to interpretation of data, critically revised the manuscript, and approved the final manuscript. Acknowledgements During the preparation of this manuscript, the authors used OpenAI for language editing and formatting assistance. The authors reviewed and edited the output as needed and take full responsibility for the content of the manuscript. Authors' information Not applicable. Data Availability The data that support the findings of this study are available from the HCUP National Inpatient Sample, subject to HCUP purchase and data use agreement restrictions. These source data are therefore not publicly available. Summary source data underlying the tables and figures are provided in Additional file 1. Analytic code is available from the corresponding author on reasonable request. References Adler Y, Ristić AD, Imazio M, Brucato A, Pankuweit S, Burazor I, et al. Cardiac tamponade. Nat Rev Dis Primers. 2023;9(1):36. 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Rafique AM, Patel N, Biner S, Eshaghian S, Mendoza F, Cercek B, et al. Frequency of recurrence of pericardial tamponade in patients with extended versus nonextended pericardial catheter drainage. Am J Cardiol. 2011;108(12):1820–5. Saka AH, Giaquinto AN, McCullough LE, Tossas KY, Star J, Jemal A, et al. Cancer statistics for African American and Black people, 2025. CA Cancer J Clin. 2025;75(2):111–40. Menees DS, Peterson ED, Wang Y, Curtis JP, Messenger JC, Rumsfeld JS, et al. Door-to-Balloon Time and Mortality among Patients Undergoing Primary PCI. N Engl J Med. 2013;369(10):901–9. Xian Y, Xu H, Smith EE, Saver JL, Reeves MJ, Bhatt DL, et al. Achieving More Rapid Door-to-Needle Times and Improved Outcomes in Acute Ischemic Stroke in a Nationwide Quality Improvement Intervention. Stroke. 2022;53(4):1328–38. Mac Grory B, Asif KS, Xu H, Alhanti B, Hasan JBL. Association of Component Strategies of the Target Stroke Phase 3 Nationwide Quality Improvement Program With Accelerated Door-to-Puncture and Door-In-Door-Out Times for Ischemic Stroke Endovascular Thrombectomy in the United States. Circ Cardiovasc Qual Outcomes. 2025;18(11):e012456. Goodman A, Perera P, Mailhot T, Mandavia D. The role of bedside ultrasound in the diagnosis of pericardial effusion and cardiac tamponade. J Emerg Trauma Shock. 2012;5(1):72–5. Hoch VC, Abdel-Hamid M, Liu J, Hall AE, Theyyunni N, Fung CM, editors. ED point-of-care ultrasonography is associated with earlier drainage of pericardial effusion: A retrospective cohort study. Am J Emerg Med. 2022;60:156 – 63. Additional Declarations No competing interests reported. Supplementary Files CardioOncologyAdditionalFile1.xlsx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 19 Apr, 2026 Reviewers agreed at journal 14 Apr, 2026 Reviewers agreed at journal 26 Mar, 2026 Reviewers invited by journal 26 Mar, 2026 Editor assigned by journal 17 Mar, 2026 Submission checks completed at journal 12 Mar, 2026 First submitted to journal 11 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9098532","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":612780379,"identity":"ea98a65e-e7b9-4f2c-8ca8-01a1f6836d57","order_by":0,"name":"Chanokporn Puchongmart","email":"","orcid":"","institution":"Texas Tech University Health Sciences Center","correspondingAuthor":false,"prefix":"","firstName":"Chanokporn","middleName":"","lastName":"Puchongmart","suffix":""},{"id":612780380,"identity":"d94e9498-4bec-4fde-90ef-333aa1a5a518","order_by":1,"name":"Nithila Sivakumar","email":"data:image/png;base64,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","orcid":"","institution":"Texas Tech University Health Sciences Center","correspondingAuthor":true,"prefix":"","firstName":"Nithila","middleName":"","lastName":"Sivakumar","suffix":""},{"id":612780381,"identity":"d892360e-af74-4b66-b374-62b5f861f95a","order_by":2,"name":"Panat Yanpiset","email":"","orcid":"","institution":"Texas Tech University Health Sciences Center","correspondingAuthor":false,"prefix":"","firstName":"Panat","middleName":"","lastName":"Yanpiset","suffix":""},{"id":612780382,"identity":"22c3cce0-4902-469a-b3e5-2afcbc17e3bf","order_by":3,"name":"Natnicha Leelaviwat","email":"","orcid":"","institution":"Texas Tech University Health Sciences Center","correspondingAuthor":false,"prefix":"","firstName":"Natnicha","middleName":"","lastName":"Leelaviwat","suffix":""},{"id":612780383,"identity":"59075047-19f6-488a-a0e3-5c5fb8b30479","order_by":4,"name":"Dina Soliman","email":"","orcid":"","institution":"Texas Tech University Health Sciences Center","correspondingAuthor":false,"prefix":"","firstName":"Dina","middleName":"","lastName":"Soliman","suffix":""},{"id":612780384,"identity":"00a96d5d-a266-494e-8dd5-6fc1a8b05118","order_by":5,"name":"Thitiphan Srikulmontri","email":"","orcid":"","institution":"Jefferson Einstein Philadelphia Hospital","correspondingAuthor":false,"prefix":"","firstName":"Thitiphan","middleName":"","lastName":"Srikulmontri","suffix":""},{"id":612780385,"identity":"db8ef765-28e0-48ba-8b79-3fe8b6d00148","order_by":6,"name":"Thanaboon Yinadsawaphan","email":"","orcid":"","institution":"University of Hawai‘i","correspondingAuthor":false,"prefix":"","firstName":"Thanaboon","middleName":"","lastName":"Yinadsawaphan","suffix":""},{"id":612780386,"identity":"c0308d48-f149-43d3-bccd-6fe9bf5978c0","order_by":7,"name":"Narathorn Kulthamrongsri","email":"","orcid":"","institution":"University of Hawai‘i","correspondingAuthor":false,"prefix":"","firstName":"Narathorn","middleName":"","lastName":"Kulthamrongsri","suffix":""}],"badges":[],"createdAt":"2026-03-11 23:38:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9098532/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9098532/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105874418,"identity":"b1edd3e1-a50e-4e64-9e2e-983e7eae9ae4","added_by":"auto","created_at":"2026-04-01 05:26:18","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":147594,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCancer type distribution among included hospitalizations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHorizontal bar chart showing the 10 most common cancer categories among cancer-related hospitalizations with cardiac tamponade that underwent pericardiocentesis or pericardial drainage. Values are survey-weighted percentages; the full cancer subtype distribution is provided in Additional file 1.\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9098532/v1/d5b9efdcb3e8be3e938ec043.jpg"},{"id":105874404,"identity":"5284d25e-dab6-4edf-b55a-b5671a86c91e","added_by":"auto","created_at":"2026-04-01 05:26:16","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":198764,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAdjusted odds of in-hospital mortality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eForest plot of adjusted odds ratios with 95% confidence intervals from the multivariable survey-weighted logistic regression model. The dashed vertical line indicates an odds ratio of 1.0.\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9098532/v1/b487d70b5c787ab2ffcd5f54.jpg"},{"id":105874488,"identity":"ac384d0c-2f18-4375-aef5-36f4a4f220cf","added_by":"auto","created_at":"2026-04-01 05:26:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1155069,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9098532/v1/9f22ce53-9142-4525-b840-cf3f71abea08.pdf"},{"id":105874371,"identity":"75aeeb0c-8ac0-4c6c-9fd4-293aa133bb3f","added_by":"auto","created_at":"2026-04-01 05:26:09","extension":"xlsx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":18444,"visible":true,"origin":"","legend":"","description":"","filename":"CardioOncologyAdditionalFile1.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-9098532/v1/08fd1f7e937ff027484e03a7.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Timing of Pericardiocentesis and In-Hospital Outcomes in Cancer Patients With Cardiac Tamponade: A Retrospective Cross-Sectional National Inpatient Sample Study","fulltext":[{"header":"Background","content":"\u003cp\u003eCardiac tamponade is a time-critical hemodynamic emergency in which rising intrapericardial pressure restricts ventricular filling, reduces stroke volume and cardiac output, and can rapidly progress to shock and death without prompt intervention (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Among clinically significant causes of pericardial effusion and tamponade, cancer remains an important driver, through metastatic involvement, direct tumor extension, treatment-related injury, or coexisting systemic illness (\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6 CR7\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Respiratory malignancies are frequently represented in malignant pericardial disease cohorts, and breast cancer is also commonly encountered (\u003cspan additionalcitationids=\"CR5 CR6 CR7\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePericardiocentesis is the definitive and potentially reversible treatment for tamponade physiology. Although current guidance emphasizes urgent decompression, real-world drainage timing may still be influenced by diagnostic delay, hemodynamic uncertainty, thrombocytopenia or coagulopathy, anticoagulation status, consultant availability, and procedural access (\u003cspan additionalcitationids=\"CR10 CR11 CR12\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In cancer populations, these competing clinical considerations may be especially relevant because advanced malignancy, bleeding risk, and goals-of-care discussions often coexist at presentation.\u003c/p\u003e \u003cp\u003eEvidence evaluating the relationship between drainage timing and in-hospital outcomes in cancer patients with cardiac tamponade remains limited. We therefore used the U.S. National Inpatient Sample (NIS) to examine cancer-related hospitalizations complicated by cardiac tamponade in which pericardiocentesis or pericardial drainage was performed, and to compare outcomes between early drainage on hospital day 0 and delayed drainage on hospital day 1 or later.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and data source\u003c/h2\u003e \u003cp\u003eWe performed a retrospective cross-sectional study using the Healthcare Cost and Utilization Project (HCUP) NIS from 2016 through 2022. The NIS is a nationally representative, all-payer inpatient discharge database. Diagnoses are coded using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), and inpatient procedures are coded using the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS). The unit of analysis was the hospitalization.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eWe included adult hospitalizations (age\u0026thinsp;\u0026ge;\u0026thinsp;18 years) with cardiac tamponade recorded as a principal or secondary diagnosis (ICD-10-CM I31.4) and a concomitant cancer diagnosis identified using HCUP Clinical Classifications Software Refined cancer categories in any diagnosis field. We required that pericardiocentesis or pericardial drainage be performed during the same admission, identified by ICD-10-PCS pericardial cavity drainage codes in any procedure field: 0W9D30Z, 0W9D3ZX, 0W9D3ZZ, 0W9D40Z, 0W9D4ZX, and 0W9D4ZZ. Admissions classified as non-melanoma skin cancer were excluded.\u003c/p\u003e\n\u003ch3\u003eExposure and outcomes\u003c/h3\u003e\n\u003cp\u003ePericardiocentesis timing was determined using the NIS days-from-admission-to-procedure variable and defined according to the earliest qualifying pericardial drainage procedure day across all listed procedures. Early drainage was defined as hospital day 0, and delayed drainage as hospital day 1 or later. The primary outcome was in-hospital mortality. Secondary outcomes were hospital length of stay and total hospital charges. Charges were inflation-adjusted using Bureau of Labor Statistics price indices. Comorbidities were identified using HCUP Elixhauser comorbidity software.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAll analyses used survey-weighted methods to account for the complex sampling design of the NIS and to generate national estimates. Continuous variables were summarized as survey-weighted means with standard errors, and categorical variables as survey-weighted percentages. In-hospital mortality was compared between drainage-timing groups using survey-weighted cross-tabulations. Length of stay and inflation-adjusted total charges were compared using survey-weighted regression methods. We then fitted a multivariable survey-weighted logistic regression model with in-hospital mortality as the dependent variable. Drainage timing was the primary exposure, and covariates included age, sex, race or ethnicity, hypertension, diabetes mellitus, and selected clinically relevant Elixhauser comorbidity indicators. Results are reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). A two-sided p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. Analyses were performed using Stata/MP 18.0 (StataCorp, College Station, TX, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eWe identified 2255 cancer-related hospitalizations complicated by cardiac tamponade in which pericardiocentesis or pericardial drainage was performed. Of these, 1140 (50.6%) underwent early drainage on hospital day 0 and 1115 (49.4%) underwent delayed drainage on hospital day 1 or later. Selected baseline characteristics are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, and the full baseline table is provided in Additional file 1. The mean age was 59.25 years in the early-drainage group and 56.66 years in the delayed-drainage group (p\u0026thinsp;=\u0026thinsp;0.07). Female sex distribution was similar between groups (49.56% vs 50.90%; p\u0026thinsp;=\u0026thinsp;0.775). Overall race or ethnicity distribution did not differ significantly (p\u0026thinsp;=\u0026thinsp;0.157). Diabetes mellitus was more common in the early-drainage group (22.81% vs 14.35%; p\u0026thinsp;=\u0026thinsp;0.016), whereas most other selected comorbidities were similar between groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eSelected baseline characteristics by drainage timing\u003c/b\u003e Values are survey-weighted means (SE) or percentages. The full baseline characteristics table is provided in Additional file 1.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEarly drainage (day 0)\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;1140)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDelayed drainage (day\u0026thinsp;\u0026ge;\u0026thinsp;1)\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;1115)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, mean (SE)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59.25 (0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56.66 (1.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49.56%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.775\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace or ethnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56.95%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59.45%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfrican American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18.83%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.36%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.35%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.06%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian or Pacific Islander\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.38%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.91%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNative American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.92%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.48%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50.44%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43.50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22.81%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.35%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCongestive heart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19.74%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.94%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.644\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiac arrhythmias\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42.11%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43.50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.747\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eValvular heart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.58%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.69%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.051\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary circulation disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.96%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.52%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.384\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.28%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.31%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.522\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.33%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.97%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.811\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoagulopathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.28%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.45%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.708\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.46%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.21%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.164\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetastatic cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67.98%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60.54%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMeasures of clinical acuity were also similar between groups. Shock was observed more often in the early-drainage group than in the delayed-drainage group (17.5% vs 11.7%; p\u0026thinsp;=\u0026thinsp;0.07), whereas respiratory failure occurred at comparable frequencies (22.4% vs 24.2%; p\u0026thinsp;=\u0026thinsp;0.64). The distribution of cancer subtypes is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Respiratory malignancies comprised the largest subgroup (28.3%), followed by breast cancer (8.2%). The full cancer subtype distribution is provided in Additional file 1.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn-hospital outcomes are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Delayed drainage was associated with higher unadjusted in-hospital mortality than early drainage (14.80% vs 8.77%; p\u0026thinsp;=\u0026thinsp;0.052). Delayed drainage was also associated with a longer mean length of stay (10.12 vs 7.04 days; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and higher mean inflation-adjusted total hospital charges (174178 vs 113922.9; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eIn-hospital outcomes by drainage timing\u003c/b\u003e Values are survey-weighted percentages or means (SE). Hospital charges were inflation-adjusted.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEarly drainage (day 0)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDelayed drainage (day\u0026thinsp;\u0026ge;\u0026thinsp;1)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn-hospital mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.77%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of stay, mean (SE)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.04 (0.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.12 (0.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInflation-adjusted charges, mean (SE)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e113922.9 (10415)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e174178 (20213)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e show the adjusted analysis for in-hospital mortality. Delayed pericardiocentesis remained independently associated with increased odds of in-hospital death (aOR 2.21; 95% CI 1.11\u0026ndash;4.41; p\u0026thinsp;=\u0026thinsp;0.025). Coagulopathy (aOR 3.70; 95% CI 1.62\u0026ndash;8.46; p\u0026thinsp;=\u0026thinsp;0.002), cardiac arrhythmias (aOR 2.03; 95% CI 1.01\u0026ndash;4.09; p\u0026thinsp;=\u0026thinsp;0.048), and African American race compared with White race (aOR 4.13; 95% CI 1.93\u0026ndash;8.86; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were also associated with higher in-hospital mortality. Age, sex, hypertension, congestive heart failure, valvular heart disease, pulmonary circulation disorders, renal failure, liver disease, and obesity were not significantly associated with mortality in the final model.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eAdjusted odds of in-hospital mortality\u003c/b\u003e Multivariable survey-weighted logistic regression with in-hospital mortality as the dependent variable. Reference groups were day 0 drainage, male sex, and White race.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdjusted OR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelayed drainage (day\u0026thinsp;\u0026ge;\u0026thinsp;1 vs day 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.11\u0026ndash;4.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.98\u0026ndash;1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.635\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.56\u0026ndash;1.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.889\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfrican American race (vs White)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.93\u0026ndash;8.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic race (vs White)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.59\u0026ndash;3.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.390\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther race (vs White)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.27\u0026ndash;4.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.886\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.21\u0026ndash;1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.98\u0026ndash;5.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCongestive heart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.52\u0026ndash;2.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.771\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiac arrhythmias\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.01\u0026ndash;4.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eValvular heart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.16\u0026ndash;2.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.558\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary circulation disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.14\u0026ndash;1.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.264\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.35\u0026ndash;1.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.676\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.86\u0026ndash;5.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoagulopathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.62\u0026ndash;8.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.14\u0026ndash;2.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.385\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this nationally representative analysis of cancer-related hospitalizations complicated by cardiac tamponade, delayed pericardiocentesis was associated with worse in-hospital outcomes. Compared with drainage performed on hospital day 0, delayed drainage was associated with higher in-hospital mortality, longer hospitalization, and greater inflation-adjusted hospital charges. After multivariable adjustment, delayed drainage remained independently associated with more than twofold higher odds of in-hospital death. These findings support the clinical principle that timely decompression is central to the management of tamponade in cardio-oncology practice (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur results are clinically plausible and align with existing guidance that prioritizes urgent drainage while allowing only brief deferral in carefully selected, closely monitored patients (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In real-world oncology populations, however, same-day drainage may not always be achieved because of delayed recognition, the need for confirmatory imaging, thrombocytopenia or coagulopathy, anticoagulation reversal, limited procedural availability, or competing oncologic decision-making (\u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The observation that only about half of hospitalizations underwent drainage on day 0 suggests a potentially modifiable systems-level gap in care delivery. Similar improvements in other time-sensitive cardiovascular emergencies have been achieved through standardized workflows and quality-improvement initiatives (\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe cancer subtype distribution in our cohort also supports the face validity of the study population, with respiratory malignancies and breast cancer representing the most common groups, consistent with prior reports of malignant pericardial disease (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR5 CR6 CR7\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In the adjusted model, coagulopathy and cardiac arrhythmias were also associated with higher in-hospital mortality, which is clinically plausible in a population characterized by hemodynamic instability, advanced malignancy, and procedure-related bleeding risk. The higher adjusted mortality observed among African American patients warrants further investigation to clarify the potential roles of illness severity, access to timely specialty care, procedural timing, hospital-level factors, and broader structural inequities (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, the NIS is an administrative database and lacks detailed clinical information such as vital signs, echocardiographic findings, tamponade severity, laboratory values, cancer stage, treatment status, and goals of care. Second, identification of tamponade, cancer subtype, and pericardial drainage relied on ICD-10 coding and may be subject to misclassification. Third, the timing variable is derived from days from admission to procedure and may be affected by coding practices. Fourth, the database does not provide procedural granularity such as imaging guidance, drainage duration, complications, or recurrence. Finally, because this is an observational study of hospitalizations rather than unique patients, residual confounding is likely and longitudinal outcomes cannot be assessed. Despite these limitations, the large nationally representative sample provides useful real-world insight into a high-acuity cardio-oncology emergency.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAmong cancer-related hospitalizations complicated by cardiac tamponade that underwent pericardiocentesis or pericardial drainage, delayed drainage on hospital day 1 or later was independently associated with higher in-hospital mortality, longer hospitalization, and greater hospital charges. These findings identify a potentially actionable opportunity to improve care for a high-risk population by strengthening inpatient workflows that support earlier recognition and timely drainage. Prospective studies are needed to identify specific causes of delay and evaluate targeted quality-improvement strategies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eaOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eadjusted odds ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003econfidence interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHCUP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealthcare Cost and Utilization Project\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHIPAA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealth Insurance Portability and Accountability Act\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICD-10-CM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Classification of Diseases,Tenth Revision,Clinical Modification\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICD-10-PCS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Classification of Diseases,Tenth Revision,Procedure Coding System\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLOS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003elength of stay\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNIS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Inpatient Sample.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eThis study used de-identified discharge-level data from the HCUP National Inpatient Sample. Institutional review board review and informed consent were not required for this analysis of de-identified data.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors received no specific funding for this work.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eCP and NS conceived the study. CP, NS, and PY designed the analysis. CP and NS drafted the initial manuscript. CP, NS, PY, NL, DS, TS, TY, and NK contributed to interpretation of data, critically revised the manuscript, and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eDuring the preparation of this manuscript, the authors used OpenAI for language editing and formatting assistance. The authors reviewed and edited the output as needed and take full responsibility for the content of the manuscript.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAuthors' information\u003c/b\u003e \u003c/p\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are available from the HCUP National Inpatient Sample, subject to HCUP purchase and data use agreement restrictions. These source data are therefore not publicly available. Summary source data underlying the tables and figures are provided in Additional file 1. Analytic code is available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdler Y, Ristić AD, Imazio M, Brucato A, Pankuweit S, Burazor I, et al. Cardiac tamponade. Nat Rev Dis Primers. 2023;9(1):36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShenoy S, Shetty S, Lankala S, Anwer F, Yeager A, Adigopula S. Cardiovasc Oncologic Emergencies Cardiol. 2017;138(3):147\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHalfdanarson TR, Hogan WJ, Moynihan TJ. Oncologic emergencies: diagnosis and treatment. Mayo Clin Proc. 2006;81(6):835\u0026thinsp;\u0026ndash;\u0026thinsp;48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eImazio M, Demichelis B, Parrini I, Favro E, Beqaraj F, Cecchi E, et al. Relation of acute pericardial disease to malignancy. Am J Cardiol. 2005;95(11):1393\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheong XP, Law LKP, Seow SC, Tay LWE, Tan HC, Yeo WT, et al. Causes and prognosis of symptomatic pericardial effusions treated by pericardiocentesis in an Asian academic medical centre. Singap Med J. 2020;61(3):137\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLyon AR, L\u0026oacute;pez-Fern\u0026aacute;ndez T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, et al. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J. 2022;43(41):4229\u0026ndash;361.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMori S, Bertamino M, Guerisoli L, Stratoti S, Canale C, Spallarossa P, et al. Pericardial effusion in oncological patients: current knowledge and principles of management. Cardiooncology. 2024;10(1):8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMudra SE, Rayes D, Kumar AK, Li JZ, Njus M, McGowan K, et al. Malignant Pericardial Effusion: A Systematic Review. CJC Open. 2024;6(8):967\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdler Y, Charron P, Imazio M, Badano L, Bar\u0026oacute;n-Esquivias G, Bogaert J, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015;36(42):2921\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRistić AD, Imazio M, Adler Y, Anastasakis A, Badano LP, Brucato A, et al. Triage strategy for urgent management of cardiac tamponade: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2014;35(34):2279\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVirk SA, Chandrakumar D, Villanueva C, Wolfenden H, Liou K, Cao C. Systematic review of percutaneous interventions for malignant pericardial effusion. Heart. 2015;101(20):1619\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsang TS, Enriquez-Sarano M, Freeman WK, Barnes ME, Sinak LJ, Gersh BJ et al. Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns, and outcomes spanning 21 years. Mayo Clin Proc. 2002;77(5):429\u0026thinsp;\u0026ndash;\u0026thinsp;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eImazio M. Pericardiocentesis With Extended Drainage and Colchicine: New Indication for Malignant Pericardial Effusions? J Am Coll Cardiol. 2020;76(13):1562\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsang TS, Seward JB, Barnes ME, Bailey KR, Sinak LJ, Urban LH et al. Outcomes of primary and secondary treatment of pericardial effusion in patients with malignancy. Mayo Clin Proc. 2000;75(3):248\u0026thinsp;\u0026ndash;\u0026thinsp;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePepi M, Muratori M. Echocardiography in the diagnosis and management of pericardial disease. J Cardiovasc Med (Hagerstown). 2006;7(7):533\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRafique AM, Patel N, Biner S, Eshaghian S, Mendoza F, Cercek B, et al. Frequency of recurrence of pericardial tamponade in patients with extended versus nonextended pericardial catheter drainage. Am J Cardiol. 2011;108(12):1820\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaka AH, Giaquinto AN, McCullough LE, Tossas KY, Star J, Jemal A, et al. Cancer statistics for African American and Black people, 2025. CA Cancer J Clin. 2025;75(2):111\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMenees DS, Peterson ED, Wang Y, Curtis JP, Messenger JC, Rumsfeld JS, et al. Door-to-Balloon Time and Mortality among Patients Undergoing Primary PCI. N Engl J Med. 2013;369(10):901\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXian Y, Xu H, Smith EE, Saver JL, Reeves MJ, Bhatt DL, et al. Achieving More Rapid Door-to-Needle Times and Improved Outcomes in Acute Ischemic Stroke in a Nationwide Quality Improvement Intervention. Stroke. 2022;53(4):1328\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMac Grory B, Asif KS, Xu H, Alhanti B, Hasan JBL. Association of Component Strategies of the Target Stroke Phase 3 Nationwide Quality Improvement Program With Accelerated Door-to-Puncture and Door-In-Door-Out Times for Ischemic Stroke Endovascular Thrombectomy in the United States. Circ Cardiovasc Qual Outcomes. 2025;18(11):e012456.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoodman A, Perera P, Mailhot T, Mandavia D. The role of bedside ultrasound in the diagnosis of pericardial effusion and cardiac tamponade. J Emerg Trauma Shock. 2012;5(1):72\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoch VC, Abdel-Hamid M, Liu J, Hall AE, Theyyunni N, Fung CM, editors. ED point-of-care ultrasonography is associated with earlier drainage of pericardial effusion: A retrospective cohort study. Am J Emerg Med. 2022;60:156\u0026thinsp;\u0026ndash;\u0026thinsp;63.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"cardio-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"caon","sideBox":"Learn more about [Cardio-Oncology](http://cardiooncologyjournal.biomedcentral.com)","snPcode":"40959","submissionUrl":"https://submission.nature.com/new-submission/40959/3","title":"Cardio-Oncology","twitterHandle":"@OncoBioMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"cardiac tamponade, pericardiocentesis, cancer, cardio-oncology, inpatient outcomes","lastPublishedDoi":"10.21203/rs.3.rs-9098532/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9098532/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCardiac tamponade is a life-threatening complication in patients with cancer and often prompts urgent pericardial drainage. Contemporary data on how the timing of pericardiocentesis relates to outcomes in this population remain limited.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe performed a retrospective cross-sectional study of the U.S. National Inpatient Sample from 2016 to 2022. Adult hospitalizations with cardiac tamponade and a concomitant cancer diagnosis that underwent pericardiocentesis or pericardial drainage were included. Timing was categorized as early drainage (hospital day 0) or delayed drainage (hospital day\u0026thinsp;\u0026ge;\u0026thinsp;1). The primary outcome was in-hospital mortality. Secondary outcomes were length of stay and inflation-adjusted total hospital charges. Survey-weighted analyses generated national estimates, and multivariable survey-weighted logistic regression was used to estimate adjusted odds ratios for mortality.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWe identified 2255 cancer-related hospitalizations with cardiac tamponade undergoing pericardiocentesis or pericardial drainage; 1140 (50.6%) received early drainage and 1115 (49.4%) received delayed drainage. Respiratory cancers were the most common malignancy group (28.3%), followed by breast cancer (8.2%). Delayed drainage was associated with higher unadjusted in-hospital mortality than early drainage (14.8% vs 8.8%; p\u0026thinsp;=\u0026thinsp;0.052), a longer mean length of stay (10.12 vs 7.04 days; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and higher mean inflation-adjusted hospital charges (174178 vs 113922.9; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). After adjustment, delayed drainage remained independently associated with increased odds of in-hospital death (adjusted odds ratio 2.21; 95% confidence interval 1.11\u0026ndash;4.41; p\u0026thinsp;=\u0026thinsp;0.025).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAmong cancer-related hospitalizations complicated by cardiac tamponade, delayed pericardiocentesis was independently associated with higher in-hospital mortality. These findings support timely drainage and justify prospective studies to identify workflow barriers and improve acute cardio-oncology care.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Timing of Pericardiocentesis and In-Hospital Outcomes in Cancer Patients With Cardiac Tamponade: A Retrospective Cross-Sectional National Inpatient Sample Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-01 05:25:40","doi":"10.21203/rs.3.rs-9098532/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-19T12:44:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"207823933402616032989976021866400453534","date":"2026-04-14T21:03:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"109043124932261609145926851815493109259","date":"2026-03-26T15:23:46+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-26T14:38:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-17T16:46:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-12T06:04:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"Cardio-Oncology","date":"2026-03-11T23:26:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"cardio-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"caon","sideBox":"Learn more about [Cardio-Oncology](http://cardiooncologyjournal.biomedcentral.com)","snPcode":"40959","submissionUrl":"https://submission.nature.com/new-submission/40959/3","title":"Cardio-Oncology","twitterHandle":"@OncoBioMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"edd6c180-a471-4dcf-8b21-331543fe7c9c","owner":[],"postedDate":"April 1st, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-01T05:25:41+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-01 05:25:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9098532","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9098532","identity":"rs-9098532","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}