title: Paracentesis is associated with reduced mortality in patients hospitalized with cirrhosis and ascites.
abstract: OBJECTIVE
  Diagnostic paracentesis is recommended for patients with cirrhosis who are admitted to the hospital for ascites or encephalopathy. However, it is not known whether clinicians in the United States adhere to this recommendation; a relationship between paracentesis and clinical outcome has not been reported. We analyzed a U.S. database to determine the frequency of paracentesis and its association with mortality.
  
  
  METHODS
  The 2009 Nationwide Inpatient Sample (which contains data from approximately 8 million hospital discharges each year) was used to identify patients with cirrhosis and ascites who were admitted with a primary diagnosis of ascites or encephalopathy. In-hospital mortality, length of stay, and hospital charges were compared for those who did and did not undergo paracentesis. Outcomes were compared for those who received an early paracentesis (within 1 day of admission) and those who received one later.
  
  
  RESULTS
  Of 17,711 eligible admissions, only 61% underwent paracentesis. In-hospital mortality was reduced by 24% among patients who underwent paracentesis (6.5% vs 8.5%; adjusted odds ratio, 0.55; 95% confidence interval, 0.41-0.74). Most paracenteses (66%) occurred ≤1 day after admission. In-hospital mortality was lower among patients who received early paracentesis than those who received it later (5.7% vs 8.1%, P = .049), although this difference was not significant after adjustment for confounders (odds ratio, 1.26; 95% confidence interval, 0.78-2.02). Among patients who underwent paracentesis, the mean hospital stay was 14% longer and hospital charges were 29% greater than for patients who did not receive the procedure.
  
  
  CONCLUSIONS
  Paracentesis is underused for patients admitted to the hospital with ascites; the procedure is associated with increased short-term survival. These data support practice guidelines derived from expert opinion. Studies are needed to identify barriers to guideline adherence.
authors: Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: esorman@iu.edu.
authors: Eric S
authors: ES
authors: Orman
authors: Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors: Paul H
authors: PH
authors: Hayashi
authors: Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina.
authors: Ramon
authors: R
authors: Bataller
authors: Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors: A Sidney
authors: AS
authors: Barritt
mesh_terms: D000368:Aged; D001201:Ascites / Q000401:mortality* / Q000601:surgery*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000379:methods* / Q000706:statistics & numerical data; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States
keywords: Health Services; Liver Fibrosis; NIS Analysis; Peritonitis; Quality of Health Care
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