Delayed Paracentesis and Spontaneous Bacterial Peritonitis – No Increase in Mortality

Ford Parsons, MD*, Virginia Mason Medical Center, Seattle, WA

Meeting: Hospital Medicine 2016, March 6-9, San Diego, Calif.

Abstract number: 159

Categories: Patient Safety, Research Abstracts

Keywords: , , ,

Background:

Spontaneous Bacterial Peritonitis (SBP) is associated with high mortality.  A recent article[1] showed that, in the setting of SBP, delayed paracentesis was associated with increased mortality.  Because of the clinical ramifications of this association, we attempted to recreate this finding using our local patient population.

Methods:

Similar to the study that prompted this inquiry, we employed a retrospective analysis of consecutive patients admitted to the hospital—in this case, Virginia Mason Medical Center (VMMC) from 11/2005 – 11/2015.  The population was initially identified by a query of billing data for ICD-9 code 567.23 (SBP).  Inclusion criteria consisted of paracentesis fluid consistent with SBP (polymorphonuclear cells >= 250/mm^3), age > 18 years, and paracentesis delay < 72 hours.  Only index cases of SBP for each patient were included.  Early paracentesis (EP) was defined as paracentesis within 12 hours of presentation.  Delayed Paracentesis (DP) was defined as paracentesis from 12-72 hours after presentation.

Results:

110 patients with SBP were analyzed during the study period.  Of these, 65 (59%) patients received DP but had no difference in in-hospital mortality when compared to EP (14% vs. 20%, P=0.391).  This is in contrast to the cited study in which 98 (41%) patients received DP and had statistically-significantly higher in-hospital mortality than the EP group (27% vs. 13%, P=0.007).

Conclusions:

No difference in in-hospital mortality was observed with regard to the timing of paracentesis (i.e., EP vs. DP).  This unexpected finding may be due to differences in patient population (the original study contained patients from a medical center with a liver transplant program), paracentesis technique (99% of the paracenteses performed in the original study were at bedside, while at VMMC, the majority of paracenteses were performed by diagnostic radiology), or as a result of differing rates of prophylactic or empiric antibiotic administration.

[1]: Am J Gastroenterol. 2014 Sep;109(9):1436-42.

To cite this abstract:

Parsons F. Delayed Paracentesis and Spontaneous Bacterial Peritonitis – No Increase in Mortality. Abstract published at Hospital Medicine 2016, March 6-9, San Diego, Calif. Abstract 159. Journal of Hospital Medicine. 2016; 11 (suppl 1). https://www.shmabstracts.com/abstract/delayed-paracentesis-and-spontaneous-bacterial-peritonitis-no-increase-in-mortality/. Accessed September 23, 2019.

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