title: The benefit of paracentesis on hospitalized adults with cirrhosis and ascites.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Chicago Medicine, Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition.
authors.forename: John N
authors.initials: JN
authors.lastname: Gaetano
authors.affiliation: University of Chicago Medicine, Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition.
authors.forename: Dejan
authors.initials: D
authors.lastname: Micic
authors.affiliation: University of Chicago Medicine, Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition.
authors.forename: Andrew
authors.initials: A
authors.lastname: Aronsohn
authors.affiliation: University of Chicago Medicine, Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition.
authors.forename: Gautham
authors.initials: G
authors.lastname: Reddy
authors.affiliation: University of Chicago Medicine, Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition.
authors.forename: Helen
authors.initials: H
authors.lastname: Te
authors.affiliation: Rush University Medical Center, Department of Medicine, Section of Hepatology, Chicago, Illinois, USA.
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Reau
authors.affiliation: University of Chicago Medicine, Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition.
authors.forename: Donald
authors.initials: D
authors.lastname: Jensen
mesh_terms: D000368:Aged; D001201:Ascites / Q000191:economics / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications* / Q000191:economics / Q000401:mortality; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000009:adverse effects / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: ascites; cirrhosis; cost; mortality; nationwide inpatient sample; paracentesis; spontaneous bacterial peritonitis