Matthew Scott Berger, Vadim Divilov, Harold Paredes and Edward Sun
Background: Patients who are hospitalized for decompensated cirrhosis often require an abdominal paracentesis. Several studies and various societies have deemed this procedure to carry low risk of complications. However, Hospital Internists are increasingly referring this procedure to Interventional Radiology (IR) to perform. As a result, hospital costs, use of resources, and patient length of stay (LOS) have all risen. The primary aim of this study was to compare the complication rates after paracentesis performed at bedside by Internal Medicine Residents with those performed by Interventional Radiology Attendings. The secondary aim was to compare additional clinical outcomes including time to procedure, bacterial culture yield, and transfusion rates between the two groups.
Methods and Findings: A retrospective analysis was conducted of all paracentesis procedures performed on patients admitted to a single large academic tertiary care medical center from July 2017 to April 2018. Data was queried based on procedure notes and orders placed in the electronic medical record. Clinical outcomes were assessed up to 48 hours post index procedure and compared between patients who had bedside and IRguided procedures. 118 paracentesis encounters were included in the final analysis. Complication rates regarding hemorrhage, persistent leakage of fluid, abdominal perforation, and ICU transfer were similar between bedside and IR paracentesis. As for secondary outcomes, a significant different was found with regards to time to procedure. The time from procedure referral to procedure completion was less in the bedside group (5.3 hours ± 6.8 vs. 22.5 hours ± 36.5; p=0.001). However, no statistical differences were found in terms of total hospital LOS, the number of units of red blood cell, platelet or fresh-frozen plasma transfused pre- and post-procedure, bacterial fluid culture yield, and the volume of ascites removed during therapeutic paracentesis.
Conclusion: This study suggests that bedside abdominal paracentesis performed by Internal Medicine resident physicians and those performed by Interventional Radiologists have similar complication rates. Other clinical outcomes including volume removed during therapeutic paracentesis and the need for blood product transfusion were also shown to be comparable between the two groups whereas bedside paracentesis was found to be superior in terms of time to procedure. The findings of this study suggest that IR-guided paracentesis should not be favored routinely over bedside paracentesis.
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