The benefit of paracentesis on hospitalized adults with cirrhosis and ascites

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


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.

MeSH terms

  • Aged
  • Ascites / economics
  • Ascites / etiology
  • Ascites / mortality
  • Ascites / therapy*
  • Cost Savings
  • Cost-Benefit Analysis
  • Databases, Factual
  • Female
  • Hospital Costs
  • Hospital Mortality
  • Hospitalization* / economics
  • Humans
  • Length of Stay
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / economics
  • Liver Cirrhosis / mortality
  • Male
  • Middle Aged
  • Paracentesis / adverse effects
  • Paracentesis / economics
  • Paracentesis / mortality
  • Paracentesis / statistics & numerical data*
  • Quality Indicators, Health Care
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • United States