S0992 Examining Hospital Length of Stay With Early vs Late Time to Diagnostic Paracentesis

Abstract

INTRODUCTION: Diagnostic paracentesis is vital for the recognition of spontaneous bacterial peritonitis (SBP), which has a high mortality rate if not treated appropriately. Early diagnostic paracentesis (less than 24 hours) is shown to decrease mortality, length of stay, hospitalization cost, and readmission rates. We examined the time to diagnostic paracentesis in the hospitalized patient and the correlation to length of stay in our institution. METHODS: We retrospectively reviewed admissions from September 2018 to November 2019. All patients admitted to medicine services with ascites on presentation and underwent a diagnostic paracentesis were included. We recorded the time to procedure, performing department, and length of stay. Patients were separated into two groups. The early diagnostic paracentesis group received their procedure in less than 24 hours. The late diagnostic paracentesis group received their procedure in greater than 24 hours. Our primary outcome was average length of stay between the groups. RESULTS: A total of 319 patients were included. The early paracentesis group had 154 patients (48.3%) and the late paracentesis group had 165 patients (51.7%). The average length of stay for the early group was 8.4 days and for the late group, 9.8 days. This equates to a 15.4% difference in length of stay between the two groups (P = 0.013). The emergency department (ED), primary medicine teams, a dedicated procedure team, and interventional radiology (IR) performed 66, 75, 74, and 85 procedures (20.7, 23.5, 23.4, and 26.5%), respectively. Of note, the ED performed 63 (77.3%) of their 66 procedures within 24 hours and demonstrated an average length of stay of 8.3 days. By comparison, a pooled 67.5% of diagnostic paracentesis procedures were done beyond 24 hours for the primary medicine, procedure, and IR teams with an average length of stay of 9.1 days. The institutional average time to diagnostic paracentesis was 36.8 hours. CONCLUSION: The data demonstrates a notable reduction in hospital length of stay for patients with ascites that receive a diagnostic paracentesis within 24 hours of presentation. The greatest benefit was seen if the ED performed the procedure prior to hospital admission presumably resulting in faster diagnosis of SBP. Early diagnostic paracentesis leads to decreasing length of stay, which benefits both the patient and the hospital system. This conclusion provided us a clear point of emphasis for a quality improvement initiative to reduce our time to paracentesis.