S2867 Does Paracentesis Timing Impact Patients Hospitalized With Ascites? A Nationwide Analysis on Mortality and Outcomes

Introduction: Ascites is a common complication of advanced liver disease and significantly increases hospitalization rates and healthcare resource utilization. Early paracentesis has been proposed as a crucial intervention to manage complications related to ascites, but its impact on patient outcomes, such as mortality, length of stay (LOS), and healthcare costs, remains understudied in large-scale populations. This study aims to evaluate the timing of paracentesis, trends in compliance with guideline recommendations, and associated outcomes in patients hospitalized with ascites using data from the National Inpatient Sample (NIS). Methods: We conducted a retrospective cross-sectional analysis using data from the 2020 Nationwide Inpatient Sample. Adult patients hospitalized with a diagnosis of ascites were identified, and those who received early paracentesis (within 24 hours of admission) were compared to delayed (>24 hours). Outcomes assessed included in-hospital mortality, length of stay (LOS), and total hospitalization cost (TOTCHG). Multivariate logistic and linear regression analyses were employed to adjust for confounders. Statistical analyses were conducted using STATA software. Results: A total of 91,275 patients hospitalized with ascites in 2020 were included, of whom 15.7% received early paracentesis. Patients in the early paracentesis group had a mean age of 61.1 years, with 49.5% being woman. Patients who underwent early paracentesis had a significantly lower in-hospital mortality rate compared to those who did not receive early paracentesis (7.1% vs 10.1%, P < 0.001). Early paracentesis was associated with a 39% reduction in the odds of in-hospital mortality (adjusted OR 0.61, 95% CI 0.57 - 0.66, P < 0.001). Moreover, patients undergoing early paracentesis had a significantly shorter LOS (5.18 ± 0.06 days vs 9.14 ± 0.07 days, P < 0.001) and incurred notably lower hospitalization costs (mean reduction of $57,910, 95% CI -61,860 to -53,960, P < 0.001). Conclusion: Our analysis demonstrates that early paracentesis is associated with significantly improved outcomes, including lower in-hospital mortality, reduced length of stay, and decreased hospitalization costs. These findings support the timely initiation of paracentesis in patients with ascites to enhance clinical outcomes and optimize resource utilization. Further studies are warranted to validate these findings and refine clinical guidelines for the early management of ascites in hospitalized patients.