Misplaced and multiple needle insertions during paracentesis procedures can increase the risk of bleeding complications. Bedside ultrasound can improve patient safety associated with needle-based procedures.
To determine whether use of ultrasound during paracentesis reduces the risk of bleeding complications, as well as estimate healthcare utilization due to bleeding events in paracentesis patients.
We conducted an observational cohort study using 2007-2008 data from the Premier Perspective automated hospital database. The cohort included patients identified as having a paracentesis procedure (via ICD-9 and CPT codes) who were not at increased risk of bleeding complication due to other conditions or procedures. Ultrasound guidance was determined where the patient had a charge for ultrasound on the same service day as the thoracentesis procedure. Bleeding complications included hemorrhage, hematoma, and hemoperitoneum and were identified via ICD-9 codes. Adjusted risk was estimated using multivariate logistic regression, controlling for baseline variables that altered the odds ratio (OR) for ultrasound guidance by >10%. Total hospitalization cost and length of stay (LOS) were estimated for patients with and without pneumothorax using multivariate ordinary least squares (OLS) regression of natural log-transformed values and retransformed back to the original scale using Duan’s smearing estimate.
1United BioSource Corporation, Bethesda, MD, 2SonoSite Inc., Bothell, WA, 3University of Southern California, Los Angeles, CA
We identified 69,859 paracentesis patients who met all study inclusion criteria, of whom 31,649 (45%) had ultrasound guidance and 38,210 (55%) who did not. The overall rate of bleeding complications was 0.8%. After adjusting for confounding factors, the OR was 0.32 (95% CI: 0.25-0.41). Bleeding events increased the total cost of hospitalization by $19,066 (P<0.0001) and LOS by 4.3 days (P<0.0001).
In this study, ultrasound guidance was associated with a 68% reduction in bleeding complications following paracentesis procedures. These complications greatly increased hospital costs and LOS. This economic benefit of ultrasound guidance has not been demonstrated previously in a large, general population study.