title: The Impact of Tunneled Catheters for Ascites and Peritoneal Carcinomatosis on Patient Rehospitalizations.
abstract: OBJECTIVE
  The aim of the study is to assess patient outcomes, complications, impact on rehospitalizations, and healthcare costs in patients with malignant ascites treated with tunneled catheters.
  
  
  METHODS
  A total of 84 patients with malignant ascites (mean age, 60 years) were treated with tunneled catheters. Patients with peritoneal carcinomatosis and malignant ascites treated with tunneled drain catheter placement over a 3-year period were studied. Overall survival from the time of ascites and catheter placement were stratified by primary cancer and analyzed using the Kaplan-Meier method. Complications were graded by the Common Terminology Criteria for Adverse Events v3.0 (CTCAE). The differences between pre- and post-catheter admissions, hospitalizations, and Emergency Department (ED) visits, as well as related inpatient expenses were compared using paired t tests.
  
  
  RESULTS
  There were no significant differences in gender, age, or race between different primary cancer subgroups. One patient (1%) developed bleeding (CTCAE-2). Four patients (5%) developed local cellulitis (CTCAE-2). Three patients (4%) had prolonged hospital stay (between 7 and 10 days) to manage ascites-related complications such as abdominal distention, discomfort, or pain. Comparison between pre- and post-catheter hospitalizations showed significantly lower admissions (-1.4/month, p < 0.001), hospital stays (-4.2/month, p = 0.003), and ED visits (-0.9/month, p = 0.002). The pre- and post-catheter treatment health care cost was estimated using MS-DRG IPPS payment system and it demonstrated significant cost savings from decreased inpatient admissions in post-treatment period (-$9535/month, p < 0.001).
  
  
  CONCLUSIONS
  Tunneled catheter treatment of malignant ascites is safe, feasible, well tolerated, and cost effective. Tunneled catheter treatment may play an important role in improving patients' quality of life and outcomes while controlling health care expenditures.
authors.affiliation: Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Chuanxing
authors.initials: C
authors.lastname: Qu
authors.affiliation: Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale Cancer Center, Yale University School of Medicine, 330 Cedar Street, TE 2-224, New Haven, CT, 06510, USA.
authors.forename: Minzhi
authors.initials: M
authors.lastname: Xing
authors.affiliation: Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Anish
authors.initials: A
authors.lastname: Ghodadra
authors.affiliation: Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: McCluskey
authors.affiliation: Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Santos
authors.affiliation: Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. kevin.kim@yale.edu.|Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale Cancer Center, Yale University School of Medicine, 330 Cedar Street, TE 2-224, New Haven, CT, 06510, USA. kevin.kim@yale.edu.|Yale Cancer Center, New Haven, CT, USA. kevin.kim@yale.edu.
authors.forename: Hyun S
authors.initials: HS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000191:economics / Q000209:etiology / Q000628:therapy*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation; D010359:Patient Readmission / Q000191:economics; D010534:Peritoneal Neoplasms / Q000150:complications*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Health care cost; Malignant ascites; Overall survival; Rehospitalizations; Tunneled catheter