Liver Transpl. 2023 Mar 28. doi: 10.1097/LVT.0000000000000137. Online ahead of print.
BACKGROUND AND AIMS: Guidelines recommend that all hospitalized patients with cirrhosis and ascites receive an early (<24 h from admission) paracentesis. However, national data are not available regarding compliance with and consequences of this quality metric.
METHODS: We utilized the national Veterans Administration Corporate Data Warehouse and validated International Classification of Disease codes to evaluate the rate and subsequent outcomes of early, late and no paracentesis for patients with cirrhosis and ascites during their first inpatient admission between 2016-2019.
RESULTS: Of 10,237 patients admitted with a diagnosis of cirrhosis with ascites, 14.3% received an early paracentesis, 7.3% received a late paracentesis, and 78.4% never received a paracentesis. In multivariable modeling, compared to an early paracentesis: both a late paracentesis and no-paracentesis were significantly associated with increased odds of acute kidney injury (AKI) development [OR 2.16 (95% CI 1.59-2.94) and 1.34 (1.09-1.66) respectively); intensive care unit (ICU) transfer [OR = 2.43 (1.71-3.47) and 2.01 (1.53-2.69), respectively] and inpatient death [OR = 1.54 (1.03-2.29) and 1.42 (1.05-1.93), respectively].Conclusion:Nationally, only 14.3% of admitted Veterans with cirrhosis and ascites received the AASLD guideline recommended diagnostic paracentesis within 24 hours of admission. Failure to complete early paracentesis was associated with higher odds of AKI, ICU transfer, and inpatient mortality. Universal and site-specific barriers to this quality metric should be evaluated and addressed to improve patient outcomes.