NEW YORK (Reuters Health) – Paracentesis of malignant ascites can be done safely as an outpatient procedure, according to a small British study in women with ovarian cancer.
Although often done in a multi-day hospital admission, with intermittent cross-clamping to prevent hypotension, admission is often unnecessary, Dr. Roshan Agarwal of Imperial College London, the study’s senior author, told Reuters Health by email.
“The majority of these patients, based on our data, could have the ascites drainage performed safely as an outpatient procedure, having important benefits in terms of convenience and cost of hospital stay,” he said.
There are few prospective published studies on the question, but clinical practice seems to confirm that it is generally safe to drain ascites quickly and send patients home the same day.
“In our trust, we’ve been draining ascites as a day-case procedure for years,” said Alison Keen, the interim head of cancer nursing at Princess Anne Hospital in Southampton, England, in an email to Reuters Health.
In 2010, Keen — who was not involved in Dr. Agarwal’s study — authored a Cochrane Review of malignant ascites drainage for gynecological cancers.
In their new paper, published online August 9 in the British Journal of Cancer, Dr. Agarwal’s group compare the cost and outcomes of inpatient versus outpatient ascites drainage at a single hospital in London. Patients were only eligible for outpatient paracentesis if their performance status was 0-2, they were not taking warfarin, they were able to wait up to a week for drainage, and they had normal platelet counts and coagulation.
In a preliminary phase of the study (lasting from October 2010 to January 2011), 18 women had paracentesis as inpatients on 21 occasions, but without routine intermittent clamping of the drain. The average volume of fluid drained was 4500 ml; for those admitted solely for ascites drainage, the median length of stay was three days. Four patients had their drains clamped at some point because of a fall in systolic blood pressure, but none went on to develop renal dysfunction.
Next, from May to December 2011, 13 patients had paracentesis on 19 occasions.
One patient was admitted because the procedure was done late in the day; none of the outpatients developed low blood pressure or any other complication.
The investigators also compared costs between the inpatient and outpatient procedures and found that draining ascites on an outpatient basis saved at least £519 (US $814.10) per episode.
The investigators concluded that outpatient paracentesis is feasible, cost-effective and reduces hospital admissions, and should potentially be the standard of care for patients with malignant ascites.
Dr. Agarwal said that in general, paracentesis should be performed on an inpatient basis only for those patients who have to travel so far that getting to and from the hospital in a single day is difficult and for those patients who are bedbound.
Br J Cancer 2012.