Evaluation of Hospital Complications and Costs Associated with Ultrasound Guided Paracentesis

Abstract

Purpose: The management of abdominal ascites is based on identifying its etiology. Paracentesis in conjunction with analysis of ascitic fluid, permits this determination. Ultrasound is not routinely used in performing the procedure, but its application can reduce the risk of iatrogenic injury to bowel, bladder, and other organs. We performed an analysis of paracentesis procedures to determine whether the application of ultrasound guidance is associated with variations in complications or hospital costs. Methods: We used the Premier PerspectiveTM hospital database to identify patients discharged in 2008 with an ICD-9 code of 5.91 or a CPT code of 49080 or 49081, corresponding to either initial or subsequent paracentesis procedures, respectively. We determined whether a procedure was performed with or without ultrasound guidance using patient billing data. Analyses focused on the incidence of several adverse events and patients' hospitalization costs. We performed univariate and multivariable analyses to evaluate differences between the two groups. Results: We identified 1,297 paracentesis procedures, 723 (57%) with ultrasound and 560 (43%) without. The indications for paracentesis were similar between patients between the two groups, including cirrhosis, and other causes of ascites, most of which were liver-related. Overall, the incidence of serious complications was low, however, ultrasound-guided paracentesis was associated with a lower overall rate of adverse events (1.4% versus 5.1%, p=0.01), post-paracentesis infection (0.41% versus 2.44%, p=0.01), hematoma (0.0% versus 0.87%, p=0.01), and seroma (0.14% versus 1.05%, p=0.01). Patients who underwent paracentesis with ultrasound guidance also had lower mean ± SD hospitalization costs ($8,761 ± $5,956 vs. $9,848 ± $6581, p<0.001). This finding remained consistent even after adjusting for patient and hospital demographics. Conclusion: The use of ultrasound guidance to identify appropriate locations for percutaneous entry for paracentesis procedures is associated with a lower rate of complications and lower cost of hospitalization than procedures where ultrasound is not used. These findings suggest that using ultrasound guidance during paracentesis procedures is beneficial from an outcomes and cost perspective. Its use should be considered into clinical practice. Disclosure: Candace Gunnarsson is a paid consultant to GE HealthCare Pankaj Patel is an employee of GE HealthCare Frank Ernst is an employee of Premier (the database vendor). This research was supported by an industry grant from Investigator is a paid consultant to Industry … it is really not a grant but just paid consultant … Primary investigator is not an MD.