B0531 - Hospital Utilization and Survival Analysis in a Model of Outpatient Paracentesis by Interventional Radiology

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Syed Mustajab Ahmed, MD

Saint Mary's Hospital
Waterbury, Connecticut

Syed Mustajab Ahmed, MD¹, Masuma Islam, MD¹, Lasha Gogokhia, MD¹, Carolina Borz-Baba, MD¹, Simona Jakab, MD²
¹Saint Mary's Hospital, Waterbury, CT; ²Yale-New Haven Hospital, New Haven, CT

Introduction: There has been a significant change in outpatient cirrhosis care, as paracentesis is currently performed by interventional radiologists (IR) rather than gastroenterologists/hepatologists or internists. In this model of care, patients’ access could be limited by scheduling availability, and there is no evaluation of their renal function or adjustment of their medications at the time of paracentesis. This study was aimed to analyze hospital utilization and cirrhosis complications within six months of index outpatient paracentesis by IR and to identify potential areas of improvement in care.

Methods: This is a retrospective study of patients with cirrhosis and ascites who underwent outpatient paracentesis by IR from October 2015 to October 2018 at a tertiary academic medical center. We collected demographics, data on cirrhosis etiology/complications, laboratory tests, provider notes, outpatient paracenteses dates, emergency department (ED) visits, hospitalizations, and ICU admissions within the following six months post-index paracentesis. Overall survival was analyzed using product-limited survival estimates (Kaplan-Meier). The log-rank test was used to test for differences by cause. Kaplan-Meier survival curves were plotted for overall and stratified survival. Cox regression analyses examined survival by cause while controlling for age and MELD score. Hazard ratios are reported.

Results: Within 6 months from index paracentesis, 44 patients (64.7%) underwent repeat IR outpatient paracentesis (total 187 paracenteses, 4.25 paracenteses/patient); 42 (61.7%) had ER visits (total 118 ER visits, 2.8/patient), 40 (58.5%) had hospital admissions (total 88 admissions, 2.2/patient) and 11 had ICU admission. On multivariate analysis, the predictive factors for mortality were older age (p=0.04) and MELD score (p=0.082). Baseline MELD was predictive of acute kidney injury (p=0.0184), UGI bleed (p=0.0096), and ICU admission (p=0.0064). The mean overall survival was 35.6 (SD +/- 2.68) months. Mean survival stratified by cause was 36.2 (SD +/- 3.78) months for patients with cirrhosis due to alcohol use, and 41.7 (SD +/- 4.1) months for cirrhosis due to hepatitis B or C.

Discussion: In this contemporary cohort of patients with cirrhosis undergoing IR outpatient paracentesis, we found a high rate of short-term cirrhosis complications and hospital utilization, while TIPS consideration was very low. Further data is needed to identify specific gaps in care and to analyze long-term survival.

Figure: Figure 1a: Survival curve using Kaplan-Meier estimator with the cause of cirrhosis as strata. Figure 1b: Survival curve for each cause at the average age (60.5) and average MELD score (17.7)

Age	n (%)
Less than 60	32 (46.37)
60 or more	37 (53.62)
Average	60.47
Gender	n (%)
Male	49 (71.01)
Female	20 (28.98)
Cause of Cirrhosis	n (%)
Alcohol	37 (53.62)
Hepatitis B and/or C	15 (21.74)
Other	17 (24.64)
Most common reasons for admissions	%
Hepatic encephalopathy	39.7%
Acute Kidney Injury	38.2%
Upper gastrointestinal (UGI) bleed	14.7%
Spontaneous bacterial peritonitis (SBP)	14.7%
6-month mortality rate	6.9%
TIPS	n (%)
TIPS performed	4 (0.09)
No documentation of TIPS consideration	31 (70.4)

Table: Table 1 demonstrates baseline demographics such as age, gender, and cause of cirrhosis, the most common reasons for readmissions with a 6-month mortality rate, and TIPS status

Disclosures:

Syed Mustajab Ahmed indicated no relevant financial relationships.

Masuma Islam indicated no relevant financial relationships.

Lasha Gogokhia indicated no relevant financial relationships.

Carolina Borz-Baba indicated no relevant financial relationships.

Simona Jakab indicated no relevant financial relationships.

Syed Mustajab Ahmed, MD¹, Masuma Islam, MD¹, Lasha Gogokhia, MD¹, Carolina Borz-Baba, MD¹, Simona Jakab, MD². B0531 - Hospital Utilization and Survival Analysis in a Model of Outpatient Paracentesis by Interventional Radiology, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.