Safety, cost-effectiveness and feasibility of daycase paracentesis in the management of malignant ascites with a focus on ovarian cancer

Abstract

Background:Paracentesis for malignant ascites is usually performed as an in-patient procedure, with a median length of stay (LoS) of 3–5 days, with intermittent clamping of the drain due to a perceived risk of hypotension. In this study, we assessed the safety of free drainage and the feasibility and cost-effectiveness of daycase paracentesis.Method:Ovarian cancer admissions at Hammersmith Hospital between July and October 2009 were audited (Stage 1). A total of 21 patients (Stage 2) subsequently underwent paracentesis with free drainage of ascites without intermittent clamping (October 2010–January 2011). Finally, 13 patients (19 paracenteses, Stage 3), were drained as a daycase (May–December 2011).Results:Of 67 patients (Stage 1), 22% of admissions and 18% of bed-days were for paracentesis, with a median LoS of 4 days. In all, 81% of patients (Stage 2) drained completely without hypotension. Of four patients with hypotension, none was tachycardic or symptomatic. Daycase paracentesis achieved complete ascites drainage without complications, or the need for in-patient admission in 94.7% of cases (Stage 3), and cost £954 compared with £1473 for in-patient drainage.Conclusions:Free drainage of malignant ascites is safe. Daycase paracentesis is feasible, cost-effective and reduces hospital admissions, and potentially represents the standard of care for patients with malignant ascites.

Drainage of malignant ascites: patient selection and perspectives

“…PC brings immediate but temporary relief in 78%–90% of cases, and implies multiple hospitalizations 2,10,17. This approach is undertaken in hospital, as a day-case or inpatient procedure 18. Patients often wait until fluid accumulation is substantial to avoid frequent hospital stays, and to ensure the ascites is amenable to drainage, resulting in a deterioration in their quality of life (QOL) 16…”

Permanent peritoneal ports for the management of recurrent malignant ascites: a retrospective review of safety and efficacy

“…Intravenous fluid replacement was not performed as part of our drainage protocol. Previous studies have suggested that free drainage of malignant ascites is safe and not associated with significant hypotension . The use of intravenous fluids including albumin infusions is not routinely recommended during or after paracentesis for malignant ascites .…”

“…Previous studies have suggested that free drainage of malignant ascites is safe and not associated with significant hypotension. 13,14 The use of intravenous fluids including albumin infusions is not routinely recommended during or after paracentesis for malignant ascites. 15 Patients in only two of the six studies of peritoneal ports received intravenous albumin.…”

Abdominal paracentesis: use of a standardised procedure checklist and equipment kit improves procedural quality and reduces complications

“…Eight grams of albumin in 20% solution per litre drained, immediately after completing the procedure, is a common recommendation . There are no data to support volume expansion with albumin following therapeutic drainage of malignant ascites …”

“…However, it is generally accepted that one total paracentesis is safer than repeated paracenteses, provided volume expansion is administered to cirrhotic patients . A patient requiring therapeutic paracentesis should be quickly drained in a single session, ideally over 1–4 h with a drain dwell time no longer than 6 h …”