title: Safety, cost-effectiveness and feasibility of daycase paracentesis in the management of malignant ascites with a focus on ovarian cancer.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Oncology, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK.
authors.forename: V
authors.initials: V
authors.lastname: Harding
authors.forename: E
authors.initials: E
authors.lastname: Fenu
authors.forename: H
authors.initials: H
authors.lastname: Medani
authors.forename: R
authors.initials: R
authors.lastname: Shaboodien
authors.forename: S
authors.initials: S
authors.lastname: Ngan
authors.forename: H K
authors.initials: HK
authors.lastname: Li
authors.forename: R
authors.initials: R
authors.lastname: Burt
authors.forename: N
authors.initials: N
authors.lastname: Diamantis
authors.forename: M
authors.initials: M
authors.lastname: Tuthill
authors.forename: S
authors.initials: S
authors.lastname: Blagden
authors.forename: H
authors.initials: H
authors.lastname: Gabra
authors.forename: C E
authors.initials: CE
authors.lastname: Urch
authors.forename: S
authors.initials: S
authors.lastname: Moser
authors.forename: R
authors.initials: R
authors.lastname: Agarwal
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000191:economics; D001201:Ascites / Q000000981:diagnostic imaging / Q000191:economics / Q000209:etiology / Q000601:surgery*; D003362:Cost-Benefit Analysis; D019468:Disease Management; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008131:London; D008499:Medical Records; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000150:complications* / Q000191:economics*; D010166:Palliative Care / Q000379:methods; D019152:Paracentesis / Q000009:adverse effects* / Q000191:economics* / Q000379:methods; D061214:Patient Safety; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D006113:United Kingdom