Evaluation of hospital complications and costs associated with using ultrasound guidance during abdominal paracentesis procedures

Abstract

Objective:

Abdominal paracentesis is commonly performed for diagnostic, therapeutic, and palliative indications, but the use of ultrasound guidance for these procedures is relatively recent, variable, and not well documented. A retrospective database analysis of abdominal paracentesis procedures was performed to determine whether ultrasound guidance was associated with differences in adverse events (AEs) or hospital costs, compared to procedures without ultrasound guidance.

Methods:

The hospital database maintained by Premier was used to identify patients with abdominal paracentesis International Classification of Diseases – 9th Revision – Clinical Modification (ICD-9 code 54.9, Common Procedural Terminology CPT-4 codes 49080, 49081) in 2008. Use of ultrasound guidance was determined via patient billing data. The incidence of selected AEs and patients’ hospitalization costs were calculated for two groups: procedures with ultrasound guidance and those without. Univariate and multivariable analyses were performed to evaluate differences between groups.

Results:

This study identified 1297 abdominal paracentesis procedures, 723 (56%) with ultrasound and 574 (44%) without. The indications for paracentesis were similar between the two groups. The incidence of AEs was lower in ultrasound-guided procedures: all AEs (1.4% vs 4.7%, p = 0.01), post-paracentesis infection (0.41% vs 2.44%, p = 0.01), hematoma (0.0% vs 0.87%, p = 0.01), and seroma (0.14% vs 1.05%, p = 0.03). Analyses adjusted for patient and hospital covariates revealed significant reductions in AEs (OR = 0.349, 95% CI = 0.165, 0.739, p = 0.0059) and hospitalization costs ($8761 ± $5956 vs $9848 ± $6581, p < 0.001) for procedures with ultrasound guidance vs those without.

Limitations:

There are several limitations to using claims data for clinical analyses; causality cannot be determined, the possibility of miscoded or missing data, and the inability to control for elements not captured in claims data that may influence clinical outcomes.

Conclusions:

The use of ultrasound guidance in abdominal paracentesis procedures is associated with fewer AEs and lower hospitalization costs than procedures where ultrasound is not used.

Key words::

• Ultrasound
• Paracentesis
• Adverse events
• Hospital costs

Transparency

Declaration of funding

Funding for the study was provided by GE Healthcare. Pankaj A. Patel participated in the planning and conducting of the study, interpreting data, and drafting the manuscript. Frank R. Ernst participated in the planning and conducting of the study, collecting and interpreting data, and drafting the manuscript. Candace L. Gunnarsson participated in the planning and conducting of the study, interpreting data, and drafting the manuscript. All authors have approved the final draft submitted.

Declaration of financial/other relationships

Pankaj A. Patel is an employee of GE Healthcare, which sponsored the study. Frank R. Ernst is employed by Premier healthcare alliance, which contracted with GE healthcare to conduct the study. Candace L. Gunnarsson is a paid consultant to GE Healthcare, through S² Statistical Solutions, Inc.

Acknowledgments

No assistance in the preparation of this article is to be declared.