Background: Patients with refractory ascites often require large volume paracentesis (LVP) on a frequent basis. Most of the studies examining the clinical effects of LVPs, however, have looked only at one-time procedures. In addition, patients with ascites commonly present to the emergency department or require hospital admission for this procedure, leading to high health-care utilization. Our aim was to assess the effects of performing multiple LVPs in a clinic setting on clinical outcomes and healthcare utilization.
Methods: In September 2011 we began a weekly paracentesis clinic at our institution. This clinic typically sees 4-5 patients per clinic half-day, with a maximum of 6 liters of ascitic fluid removed per patient per visit. We performed a retrospective review of the charts for patients seen in this clinic over a 2 year period to examine clinical outcomes.
Results: A total of 228 procedures were performed on 75 patients. Average fluid removal was 4.1 liters. After exclusions, there was pre- and post-laboratory data available for 128 procedures. There was no statistically significant difference between pre- and post-procedural values for sodium, BUN, or creatinine. The most common procedural complication was persistent ascites leak, seen in 7.9% of patients. Regarding healthcare utilization, there were a total of 196 ED visits (2.61 per patient/year) and 173 hospitalizations (2.31) in the year preceding each patient’s first clinic visit compared to 117 ED visits (1.56) and 126 hospitalizations (1.68) in the year following. When adjusted for patient mortality, however, pre- and post-data was similar. Mortality in this patient population is high, with 57% of patients dying within one year of their initial appointment.
Conclusions: Repeated LVP in the outpatient setting appears to be safe for the treatment of refractory ascites, with no statistically significant deleterious effects on renal function or serum sodium. The effects on healthcare utilization are less clear from our study, but warrant further evaluation in the future given the high utilization of this patient population.