Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
Am J Med. 2013 Apr;126(4):349-56. doi: 10.1016/j.amjmed.2012.09.016. Epub 2013 Feb 8.
Increasingly, paracentesis procedures are performed in interventional radiology (IR) rather than at the bedside. No guidelines exist to aid decision-making about the best location, and patient outcomes are unknown. Our aims were to develop a prediction model for which location (bedside vs IR) clinicians select for inpatient paracentesis procedures, and to compare clinical outcomes.
We performed an observational medical records review of all paracentesis procedures performed on the hepatology service of an 894-bed urban tertiary care hospital from July 2008 through December 2011. We developed a prediction model to determine factors for IR referral. Clinical outcomes including blood product transfusions, intensive care unit (ICU) transfer, hospital length of stay, inpatient mortality, 30-day readmission, and emergency department visit within 30 days of discharge were compared between patients who had bedside versus IR procedures.
Five hundred two patients who underwent a paracentesis were included in the analysis. Being female, higher body mass index, lower volume of ascites removed, and attending physician of record predicted the probability of IR referral. IR referrals were associated with 1.86 additional hospital days (P=.003). Platelet and fresh frozen plasma transfusions were more common in patients who underwent IR procedures (odds ratio [OR] 4.56; 95% confidence interval [CI], 2.13-9.78 and OR 4.07; 95% CI, 2.03-8.18, respectively). Subsequent ICU transfers also were more common among patients who had IR procedures (OR 2.21; 95% CI, 1.13-4.31). All other clinical outcomes were similar between groups.
The decision to perform a paracentesis procedure at the bedside or in IR is largely discretionary. Paracentesis procedures performed at the bedside result in equal or better patient outcomes. Clinicians should receive the training needed to perform paracentesis procedures safely at the bedside. Large prospective studies are needed to confirm the findings of this study and inform national practice patterns.
越来越多的腹腔穿刺术是在介入放射科（IR）而不是在床边进行的。目前尚无指南可帮助决策最佳位置，并且患者结局未知。我们的目的是开发一种预测模型，以确定临床医生选择住院患者进行腹腔穿刺术的位置（床边与 IR），并比较临床结局。
我们对 2008 年 7 月至 2011 年 12 月在一家拥有 894 张床位的城市三级保健医院的肝病科进行的所有腹腔穿刺术的医疗记录进行了观察性回顾。我们开发了一个预测模型，以确定 IR 转诊的因素。临床结局包括输血、转入重症监护病房（ICU）、住院时间、住院死亡率、出院后 30 天内再入院和出院后 30 天内急诊就诊，比较床边和 IR 操作的患者之间的差异。
共纳入 502 例接受腹腔穿刺术的患者进行分析。女性、更高的体重指数、更低的腹水清除量和记录在案的主治医生预测了 IR 转诊的可能性。IR 转诊与额外住院天数增加 1.86 天相关（P=0.003）。接受 IR 手术的患者更常需要血小板和新鲜冷冻血浆输血（比值比[OR] 4.56；95%置信区间[CI]，2.13-9.78 和 OR 4.07；95%CI，2.03-8.18）。接受 IR 手术的患者随后转入 ICU 的情况也更为常见（OR 2.21；95%CI，1.13-4.31）。两组之间的所有其他临床结局相似。
床边或 IR 进行腹腔穿刺术的决策在很大程度上是任意的。床边进行的腹腔穿刺术可获得同等或更好的患者结局。临床医生应接受在床边安全进行腹腔穿刺术的培训。需要进行大型前瞻性研究来证实本研究的结果，并为国家实践模式提供信息。
