C0496 - Hospital Admission Time and Paracentesis Administration Among Patients With Cirrhosis

Nikisha Pandya, MD, Pawel Szurnicki, MD, Mohammad Choudhry, MD, Amanda Eng, DO, Muhammad Abdullah, MD, Joshua Fogel, PhD
Coney Island Hospital, Brooklyn, NY

Introduction: Decompensated cirrhosis is a common presentation in patients requiring inpatient care. According to 2012 guidelines from AASLD, paracentesis should be performed in patients admitted to the hospital with ascites regardless of the reason for admission. This retrospective study hypothesizes that evening admission will be positively associated with delay in paracentesis (defined as 12-hour paracentesis delay) and non-optimal treatment choice of paracentesis being done after antibiotic administration.

Methods: 138 patients admitted with ascites secondary to cirrhosis between March 2017 and February 2021 were included. Variables studied included hospital admission of day (7 AM to 6:59 PM) versus evening (7 PM to 6:59 AM), paracentesis delay (Y/N), and whether paracentesis was performed before antibiotic administration, after antibiotic administration, or not performed. IBM SPSS Statistics Version 28 and Stata SE Version 17 were used for the analyses. P-values were two-tailed with alpha level for significance at p< 0.05.

Results: We found that of all patients, 39% had paracentesis after antibiotic administration, 43% did not have paracentesis at all and 37% had delayed paracentesis. During evening admission, fewer patients were likely to have paracentesis before antibiotic administration (p=0.096). In analyses comparing paracentesis after antibiotic administration with paracenteses before antibiotic administration, evening admission was significantly associated with an increased relative risk for paracentesis after antibiotic administration (p 0.046). Also, when combining the groups of paracenteses after antibiotic administration with paracentesis not done, evening admission was associated with the lowest frequency of paracentesis before antibiotic administration (p=0.03).

Discussion: The benefits of early paracentesis outweigh the risks of infection or bleeding associated with the procedure. Performing paracentesis has a greater diagnostic yield if done prior to antibiotic administration, as even a 6-hour delay can decrease infection detection rate. We found that overall, fewer patients with ascites received paracentesis, and evening admission was associated with suboptimal management with paracentesis done after antibiotic administration. Based on the above findings, there is room for improvement in educating all clinicians, particularly those working during the evening shift, on the importance of performing paracentesis prior to antibiotic administration.


Disclosures:


Nikisha Pandya, MD, Pawel Szurnicki, MD, Mohammad Choudhry, MD, Amanda Eng, DO, Muhammad Abdullah, MD, Joshua Fogel, PhD. C0496 - Hospital Admission Time and Paracentesis Administration Among Patients With Cirrhosis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.