Format

Send to

Choose Destination
J Gastroenterol Hepatol. 2016 May;31(5):1025-30. doi: 10.1111/jgh.13255.

The benefit of paracentesis on hospitalized adults with cirrhosis and ascites.

Author information

1
University of Chicago Medicine, Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition.
2
Rush University Medical Center, Department of Medicine, Section of Hepatology, Chicago, Illinois, USA.

Abstract

BACKGROUND AND AIM:

The aim of this study is to assess paracentesis utilization and outcomes in hospitalized adults with cirrhosis and ascites.

METHODS:

The 2011 Nationwide Inpatient Sample was used to identify adults, non-electively admitted with diagnoses of cirrhosis and ascites. The primary endpoint was in-hospital mortality. Variables included patient and hospital demographics, early (Day 0 or 1) or late (Day 2 or later) paracentesis, hepatic decompensation, and spontaneous bacterial peritonitis.

RESULTS:

Out of 8 023 590 admissions, 31 614 met inclusion criteria. Among these hospitalizations, approximately 51% (16 133) underwent paracentesis. The overall in-hospital mortality rate was 7.6%. There was a significantly increased mortality among patients who did not undergo paracentesis (8.9% vs 6.3%, P < 0.001). Patients who did not receive paracentesis died 1.83 times more often in the hospital than those patients who did receive paracentesis (95% confidence interval 1.66-2.02). Patients undergoing early paracentesis showed a trend towards reduction in mortality (5.5% vs 7.5%) compared with those undergoing late paracentesis. Patients admitted on a weekend demonstrated less frequent use of early paracentesis (50% weekend vs 62% weekday) and demonstrated increased mortality (adjusted odds ratio 1.12 95% confidence interval 1.01-1.25). Among patients diagnosed with spontaneous bacterial peritonitis, early paracentesis was associated with shorter length of stay (7.55 vs 11.45 days, P < 0.001) and decreased hospitalization cost ($61 624 vs $107 484, P < 0.001).

CONCLUSION:

Paracentesis is under-utilized among cirrhotic patients presenting with ascites and is associated with decreased in-hospital mortality. These data support the use of paracentesis as a key inpatient quality measure among hospitalized adults with cirrhosis. Future studies are needed to investigate the barriers to paracentesis use on admission.

KEYWORDS:

ascites; cirrhosis; cost; mortality; nationwide inpatient sample; paracentesis; spontaneous bacterial peritonitis

PMID:
26642977
DOI:
10.1111/jgh.13255
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center