Clinical outcomes after bedside and interventional radiology paracentesis procedures

Area of Science:

• Hepatology
• Interventional Radiology
• Medical Procedures

Background:

• Paracentesis is increasingly performed in interventional radiology (IR) instead of at the bedside.
• No current guidelines exist for selecting the optimal paracentesis location.
• Patient outcomes associated with bedside versus IR paracentesis are largely unknown.

Purpose of the Study:

• To develop a prediction model for the choice between bedside and IR paracentesis.
• To compare clinical outcomes between bedside and IR paracentesis procedures.

Main Methods:

• Observational medical records review of 502 paracentesis procedures from July 2008 to December 2011.
• Development of a prediction model for IR referral.
• Comparison of clinical outcomes including transfusions, ICU transfer, length of stay, mortality, and readmissions.

Main Results:

• Female sex, higher BMI, lower ascites volume, and attending physician predicted IR referral.
• IR referrals were associated with 1.86 additional hospital days (P=.003).
• Increased odds of platelet (OR 4.56) and FFP transfusions (OR 4.07), and ICU transfers (OR 2.21) were observed with IR procedures.

Conclusions:

• Paracentesis location (bedside vs. IR) is often discretionary.
• Bedside paracentesis yields equal or superior patient outcomes.
• Training for safe bedside paracentesis is recommended; further prospective studies are needed.