Outcomes following nurse-led day-case paracentesis

TL;DR

A nurse-led day-case paracentesis service is safe and effective for patients with cirrhosis and ascites, with high mortality rates linked to certain risk factors.

Contribution

Demonstrates the safety and effectiveness of nurse-led paracentesis services and identifies mortality risk factors in cirrhosis patients.

Findings

Nurse-led services have similar morbidity risks to physician-led services.

30- and 90-day mortality rates after TP were 21.0% and 33.1%, respectively.

Older age, hepatocellular carcinoma, and ongoing alcohol use are linked to higher 1-year mortality.

Abstract

•About 10% of patients with cirrhosis and ascites require therapeutic paracentesis (TP).•Nurse-led day-case services are being established due to rising demand for TP.•Nurse-led services have similar morbidity risks to physician-led services.•The cumulative yearly mortality rates of TP are demonstrated.

About 10% of patients with cirrhosis and ascites require therapeutic paracentesis (TP).

Nurse-led day-case services are being established due to rising demand for TP.

Nurse-led services have similar morbidity risks to physician-led services.

The cumulative yearly mortality rates of TP are demonstrated.

Therapeutic paracentesis (TP) is a key symptom-relieving intervention in refractory ascites. In response to rising demand, Nottingham University Hospitals NHS Trust was among the first UK centres to introduce a nurse-led, day-case TP service. This study evaluates the complications and mortality associated with this service.

Retrospective analysis was undertaken on patients with decompensated cirrhosis who underwent nurse-led day-case TP between 1 January 2017 and 31 December 2021. Clinical and outcome data were systematically collected.

A total of 2,530 TP procedures were performed on 340 patients. Minor (self-limiting) complications occurred in 54 cases (2.1%). In 22 cases (0.9%), patients were admitted to hospital within 7 days of TP – the reasons for admission were bacterial peritonitis (n = 11), abdominal pain (n = 3), and leakage of ascitic fluid (n = 7) or bleeding (n = 1) from the puncture site. There were no cases of abdominal visceral perforation or in-hospital deaths among those admitted.

About 290 patients were included in 1-year survival analysis. About 177 (61%) were alive 1 year after their first TP. The median time from first TP to death was 125 days (IQR 43–210). The 30- and 90-day mortality rates after TP were 21.0% and 33.1%, respectively. Older age (p < 0.001), hepatocellular carcinoma (p < 0.001) and ongoing alcohol use (p < 0.001) were independently associated with 1-year mortality.

Nurse-led, day-case TP is an effective and safe approach for managing refractory ascites in decompensated cirrhosis. Mortality remains high, particularly in patients with hepatocellular carcinoma and ongoing alcohol use.

Image, graphical abstract

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