Abstract

Background and Aim: Ascites is the most common complication of cirrhosis, and is associated with increased mortality. Diagnostic paracentesis is recommended for patients who are admitted to the hospital with ascites. However, it is unknown if diagnostic paracentesis in Canadian teaching hospitals are done according to recommended guidelines. We analyzed the rate of paracentesis, determined barriers for not performing paracentesis and the association of not performing paracentesis with mortality. Method: We conducted a retrospective chart review of inpatient records from January 2010 to May 2014 at Hamilton Health Sciences (Hamilton, Ontario). We used electronic medical records to identify patients with cirrhosis and ascites who were admitted with a primary or secondary diagnosis of ascites, spontaneous bacterial peritonitis or hepatic encephalopathy. All patients have to have a secondary diagnosis of cirrhosis. Primary point of interest was the performance of diagnostic paracentesis. We determined barriers for not performing and delaying paracentesis > 1 day after admission. We used multiple logistic regression to study the association between age, Charlson score (comorbidity score), model of end stage liver disease (MELD) score and weekend admission for patients who received and did not receive paracentesis. Mortality and hospital stay were compared for those who received and did not receive paracentesis. Results: Of 228 eligible admissions, 131 (57.5%, 95% CI 20.8%-64.0%) admissions received diagnostic paracentesis. 97 (74 %) patients received paracentesis < 24 hours after admission. After adjusting for other covariates, none of the predictors were significantly associated with the performance of paracentesis. In patients who did not receive paracentesis, 57 (79.4 %) had no documented reason for not receiving paracentesis. In patients who received delayed paracentesis, 19 (55.9 %) were related to seeking ultrasound guidance/marking. There was a statistical significant increase in the mean length of hospital stay in patients with a delayed paracentesis (12.6) compared to those with early paracentesis (8.2) (P = 0.02). There was no statistically significant difference in in-hospital mortality in patients who underwent paracentesis 15 (11.5 %) compared to those who did not undergo paracentesis 10 (10.3 %). Conclusion: In these two Canadian teaching centers, paracentesis was underutilized for patients admitted with ascites and cirrhosis. There was no clear documented reason for not receiving paracentesis in many patients. We found an increased reliance on ultrasound guidance resulted in delayed paracentesis. Delaying paracentesis was associated with longer hospital stay. Larger studies are needed to determine the effect of not performing paracentesis on mortality.

Authors and Affiliations