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. 2012 Sep 4;107(6):925-30.
doi: 10.1038/bjc.2012.343. Epub 2012 Aug 9.

Safety, cost-effectiveness and feasibility of daycase paracentesis in the management of malignant ascites with a focus on ovarian cancer

V Harding  1 , E Fenu, H Medani, R Shaboodien, S Ngan, H K Li, R Burt, N Diamantis, M Tuthill, S Blagden, H Gabra, C E Urch, S Moser, R Agarwal
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Safety, cost-effectiveness and feasibility of daycase paracentesis in the management of malignant ascites with a focus on ovarian cancer

V Harding et al. Br J Cancer. .

Abstract

Background: Paracentesis for malignant ascites is usually performed as an in-patient procedure, with a median length of stay (LoS) of 3-5 days, with intermittent clamping of the drain due to a perceived risk of hypotension. In this study, we assessed the safety of free drainage and the feasibility and cost-effectiveness of daycase paracentesis.

Method: Ovarian cancer admissions at Hammersmith Hospital between July and October 2009 were audited (Stage 1). A total of 21 patients (Stage 2) subsequently underwent paracentesis with free drainage of ascites without intermittent clamping (October 2010-January 2011). Finally, 13 patients (19 paracenteses, Stage 3), were drained as a daycase (May-December 2011).

Results: Of 67 patients (Stage 1), 22% of admissions and 18% of bed-days were for paracentesis, with a median LoS of 4 days. In all, 81% of patients (Stage 2) drained completely without hypotension. Of four patients with hypotension, none was tachycardic or symptomatic. Daycase paracentesis achieved complete ascites drainage without complications, or the need for in-patient admission in 94.7% of cases (Stage 3), and cost £954 compared with £1473 for in-patient drainage.

Conclusions: Free drainage of malignant ascites is safe. Daycase paracentesis is feasible, cost-effective and reduces hospital admissions, and potentially represents the standard of care for patients with malignant ascites.

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Figures

Figure 1
Figure 1
Distribution by cause of in-patient admission for ovarian cancer patients (n=67) beween July and October 2009.
Figure 2
Figure 2
Changes in heart rate (A) and SBP (B) associated with free drainage of ascites (Stage 2; n=21). Values immediately prior to drainage and at lowest for both SBP and heart rate are shown.
Figure 3
Figure 3
Time course of proportion of total ascites volume drained with free drainage (Stage 2; n=21). Individual paracentesis episodes (n=21; thin lines). Average for all patients (Bold line).
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