Safety, cost-effectiveness and feasibility of daycase paracentesis in the management of malignant ascites with a focus on ovarian cancer

Br J Cancer. 2012 Sep 4;107(6):925-30. doi: 10.1038/bjc.2012.343. Epub 2012 Aug 9.


Background: Paracentesis for malignant ascites is usually performed as an in-patient procedure, with a median length of stay (LoS) of 3-5 days, with intermittent clamping of the drain due to a perceived risk of hypotension. In this study, we assessed the safety of free drainage and the feasibility and cost-effectiveness of daycase paracentesis.

Method: Ovarian cancer admissions at Hammersmith Hospital between July and October 2009 were audited (Stage 1). A total of 21 patients (Stage 2) subsequently underwent paracentesis with free drainage of ascites without intermittent clamping (October 2010-January 2011). Finally, 13 patients (19 paracenteses, Stage 3), were drained as a daycase (May-December 2011).

Results: Of 67 patients (Stage 1), 22% of admissions and 18% of bed-days were for paracentesis, with a median LoS of 4 days. In all, 81% of patients (Stage 2) drained completely without hypotension. Of four patients with hypotension, none was tachycardic or symptomatic. Daycase paracentesis achieved complete ascites drainage without complications, or the need for in-patient admission in 94.7% of cases (Stage 3), and cost £954 compared with £1473 for in-patient drainage.

Conclusions: Free drainage of malignant ascites is safe. Daycase paracentesis is feasible, cost-effective and reduces hospital admissions, and potentially represents the standard of care for patients with malignant ascites.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Ambulatory Surgical Procedures* / adverse effects
  • Ambulatory Surgical Procedures* / economics
  • Ascites / diagnostic imaging
  • Ascites / economics
  • Ascites / etiology
  • Ascites / surgery*
  • Cost-Benefit Analysis
  • Disease Management
  • Feasibility Studies
  • Female
  • Humans
  • Length of Stay / statistics & numerical data
  • London
  • Medical Records
  • Middle Aged
  • Ovarian Neoplasms / complications*
  • Ovarian Neoplasms / economics*
  • Palliative Care / methods
  • Paracentesis / adverse effects*
  • Paracentesis / economics*
  • Paracentesis / methods
  • Patient Safety
  • Radiography
  • Retrospective Studies
  • Treatment Outcome
  • United Kingdom