One-hour Recovery Time in Subjects Undergoing Percutaneous Liver Biopsy: A Quality Improvement and Patient Safety Project

Abstract

IntroductionLiver biopsy is the gold standard in diagnosing, staging and guiding clinical management in liver disease. There are currently no standard guidelines for liver biopsy recovery time. The aims of this project are to study the safety of a one-hour recovery time after percutaneous liver biopsies and to measure the rate of complications and identify risk factors.MethodsA total of 500 consecutive subjects who underwent a percutaneous liver biopsy at a single-center teaching institution (Brooke Army Medical Center) were enrolled between December 2016 and October 2018. Biopsies were performed using a 14-gauge Bard® Monopty® core biopsy needle using bedside ultrasound. Complications were defined as: Pain level > 5 out of 10, hospitalizations, emergency department visits, or other. Major complications were defined as: hospitalizations and emergency department visits.ResultsThe only complication that required hospitalization was identified during the first hour of recovery. Liver biopsies of subjects with body mass index (BMI) ≥35 kg/m2 were not associated with more complications when compared to patients less than 30 kg/m2. Using a spinal needle (3.5’’) to anesthetize the liver capsule in subjects with excess subcutaneous tissue did not result in more complications when compared to the standard 1.5’’ needle. Only 3% of the patients who received lidocaine alone for the biopsy required post-procedure medications.ConclusionUltrasound-guided percutaneous liver biopsies, using a 14-gauge needle, were overall found to be safe. A one-hour post recovery period is adequate to identify all immediate major complications.

Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology

“…The duration of monitoring will be up to 8 hours, but for the low-risk patient with no post-biopsy complications, 3 hours' observation is usually adequate, 119 although one recent study suggested that 1 hour is enough to recognise all major complications. 185 Liver biopsy observations include monitoring the patient's pulse rate and blood pressure every 15 min for the first hour, 119 then every 30 min for 2 hours and then hourly for the remaining period. If the patient is hypotensive or tachycardic then they should receive 500 mL of 0.9% saline, unless contraindicated, and then re-evaluated.…”

“…The duration of monitoring will be up to 8 hours, but for the low-risk patient with no post-biopsy complications, 3 hours' observation is usually adequate, 119 although one recent study suggested that 1 hour is enough to recognise all major complications. 185 …”

Reducing Recovery Times in Outpatient Liver Biopsies

“…Additional studies emphasized the type of needle used, gauge size of biopsy needle, and utilization of image guidance for liver biopsies, as all of these factors can increase complication rates (Bicknell et al, 2002; Chi et al, 2017; Liane et al, 2019; Tublin et al, 2018). Larger gauge needles, 14 and 16 gauge, have been shown to pose more of a risk for complications (Bicknell et al, 2002; Liane et al, 2019; Maheux et al, 2019; Mueller et al, 2012; Tublin et al, 2018).…”

“…When considering practice changes, the effects on safety are paramount and should be supported by evidence-based literature. Seven published studies included research on patients who have shorter recovery times without negatively affecting their comfort or safety (Beddy et al, 2007; Bicknell, Richenberg, Cooperberg, Tiwari, & Halperin, 2002; Firpi et al, 2005; Liane, Dooley, Sarkar, Paredes, & Morales-Cardona, 2019; Nodarse-Perez et al, 2016; Patel & Bowman, 2018; Quaile & Dulhunty, 2017). Firpi et al (2005) included 3,214 study participants who underwent an outpatient liver biopsy procedure.…”

Fibroscan detection of fatty liver and liver fibrosis in patients with systemic lupus erythematosus

“…8,9 Even though hepatomegaly and hepatosteatosis are frequently observed in abdominal imaging performed for other reasons in SLE patients, the majority of these cases are not evaluated further since the gold standard for diagnosis is liver biopsy, an invasive procedure associated with a number of serious complications. 10 Therefore, the prognostic significance of NAFLD and liver fibrosis is still largely unknown in these patients.…”