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Delayed Diagnostic Paracentesis Is Associated with Increased Preventable Healthcare Utilization in Disadvantaged Patient Populations with Advanced Liver Disease and Elevated INR

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Abstract

Background

Patients hospitalized with cirrhosis, ascites, and elevated INR often experience delays in timely diagnostic paracentesis.

Aims

Identify whether delays in diagnostic paracentesis were associated with adverse outcomes in a hospital system serving a large disadvantaged population.

Methods

Retrospective cohort analysis of patients admitted from January 2017 to October 2019 with cirrhosis, ascites, and INR ≥ 1.5 across a multi-hospital health system in central Texas. We examined demographic and clinical characteristics of patients with diagnostic paracentesis (1) ≤ 24 h; (2) > 24 h; (3) therapeutic only or no paracentesis. We used logistic regression to examine differences in clinical outcomes controlling for confounders.

Results

479 patients met inclusion criteria. 30.0% (N = 143) were Latino, 6.7% (N = 32) African American, and 67.8% (N = 325) under or uninsured. 54.1% of patients received a diagnostic paracentesis ≤ 24 h of admission and 21.1% did not receive a diagnostic paracentesis during the hospitalization. Undergoing diagnostic paracentesis > 24 h of admission was associated with a 2.3 day increase in length of stay (95% CI 0.8–3.8), and OR 1.7 for an Emergency Room visit within 30 days of discharge (95% CI 1.1–2.7) compared to receiving a diagnostic paracentesis ≤ 24 h. Patients receiving diagnostic paracentesis in radiology were more likely to have a delay in procedure OR 5.8 (95% CI 2.8–8.6).

Conclusion

Delayed diagnostic paracentesis is associated with increased preventable healthcare utilization compared with timely diagnostic paracentesis. Health systems should support efforts to ensure timely diagnostic paracentesis for patients with advanced liver disease, including performance at the bedside.

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Funding

This publication was made possible by the Kozmetsky Family Foundation in health services research fellowship with funding of Cristal Brown’s effort.

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Authors and Affiliations

  1. Dell Medical School, University of Texas at Austin, Austin, USA

    Cristal Brown, Nazan Aksan, Patrick Chang, Priyanka Jagannathan, Maria Goretti Ochi, Michael Pignone & Linda Feagins

  2. Gastroenterology and Hepatology, The University of Texas at Austin Dell Medical School, Health Discovery Building, 1601 Trinity St Z0900, Austin, TX, 78712, USA

    Cristal Brown

Authors
  1. Cristal Brown
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  2. Nazan Aksan
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  3. Patrick Chang
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  4. Priyanka Jagannathan
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  7. Linda Feagins
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Contributions

LF, CB: Conceptualization, LF, CB, MP, NA: Methodology, CB, NA, PC, PJ, MgO: Formal analysis and investigation, CB: Writing—original draft preparation, CB, NA, MP, LF: Writing—review and editing, MP, LF: Supervision. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Cristal Brown.

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There are no conflicts of interests for any of the authors.

Ethical approval

This study was IRB approved by the University of Texas at Austin with additional approval from Ascension Seton Research Enterprise.

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Brown, C., Aksan, N., Chang, P. et al. Delayed Diagnostic Paracentesis Is Associated with Increased Preventable Healthcare Utilization in Disadvantaged Patient Populations with Advanced Liver Disease and Elevated INR. Dig Dis Sci 68, 2954–2962 (2023). https://doi.org/10.1007/s10620-023-07937-x

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  • DOI: https://doi.org/10.1007/s10620-023-07937-x

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