Weekend admissions with ascites are associated with delayed paracentesis: A nationwide analysis of the ‘weekend effect’

Gupta, Kamesh; Khan, Ahmad; Goyal, Hemant; Cal, Nicholas; Hans, Bandhul; Martins, Tiago; Ghaoui, Rony

doi:10.1016/j.aohep.2020.05.005

Cited by 7 publications

(6 citation statements)

References 33 publications

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“…We hypothesized that the percentage of timely paracenteses on weekends would be lower during the COVID‐19 era due to a reduced capacity of IR to perform these non‐urgent procedures. “The Weekend Effect” has been attributed to differences in inpatient mortality and was associated with lower rates of overall and timely paracentesis in a large database study 17 . While we observed significantly fewer paracenteses being performed on weekends during the COVID‐19 era, there was no difference in the percentage of timely paracenteses compared to the rest of the week.…”

Section: Discussioncontrasting

confidence: 48%

“…Effect" has been attributed to differences in inpatient mortality and was associated with lower rates of overall and timely paracentesis in a large database study. 17 While we observed significantly fewer paracenteses being performed on weekends during the COVID-19 era, there was no difference in the percentage of timely paracenteses compared to the rest of the week. This discordance with prior data may be related to our relatively small sample size.…”

Section: Discussionmentioning

confidence: 99%

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Rates of timely paracentesis for patients admitted to hospital with cirrhosis and ascites remain low but are unaffected by the COVID‐19 pandemic

Aby

Lall

Vasdev

et al. 2022

Journal of Hospital Medicine

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For the first 6 months of the novel coronavirus-19 (COVID-19) pandemic, the hospital medicine procedure service at our center was temporarily unavailable.We assessed paracentesis rates and clinical outcomes for patients admitted with cirrhosis and ascites before and during the COVID-19 pandemic. Two hundred and twenty-four and 131 patients with cirrhosis and ascited were admitted to hospital before and during COVID-19 respectively. Approximately 50.9% and 49.6% of patients underwent a paracentesis within 24 h pre-and mid-pandemic, p = .83. No differences were observed for length-of-stay or 30-day readmissions. GI consultation was associated with higher rates of paracentesis in both eras (p < .001 pre-COVID-19, and p = .01 COVID-19).Changes due to the COVID-19 pandemic did not result in changes to rates of timely paracentesis in patients admitted with cirrhosis and ascites. While involvement of gastroenterology may increase rates of paracentesis, further efforts are needed to optimize rates of timely paracentesis to positively impact clinical outcomes.

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Section: Discussioncontrasting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Rates of timely paracentesis for patients admitted to hospital with cirrhosis and ascites remain low but are unaffected by the COVID‐19 pandemic

Aby

Lall

Vasdev

et al. 2022

Journal of Hospital Medicine

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“…The latter are also part of system-related barriers, which we studied by involving the facility complexity scores and a significantly lower early paracentesis proportion in patients admitted over the weekend. Weekend drops in paracenteses were found in a prior study using the Nationwide Inpatient Sample, which does not include VHA data and allows for multiple admissions per person to be counted as separate events; these data extend these findings onto the VA population 23 . The results showed that although there were differences in the rate of paracentesis overall, this was primarily driven by differences in no-paracentesis versus early paracentesis in those with lower resources.…”

Section: Discussionmentioning

confidence: 58%

Early paracentesis is associated with better prognosis compared with late or no-paracentesis in hospitalized veterans with cirrhosis and ascites

Patel

Silvey

O’Leary

et al. 2023

Liver Transplantation

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Guidelines recommend that all hospitalized patients with cirrhosis and ascites receive an early (< 24 h from admission) paracentesis. However, national data are not available regarding compliance with and the consequences of this quality metric. We used the national Veterans Administration Corporate Data Warehouse and validated International Classification of Disease codes to evaluate the rate and subsequent outcomes of early, late, and no paracentesis for patients with cirrhosis and ascites during their first inpatient admission between 2016 and 2019. Of 10,237 patients admitted with a diagnosis of cirrhosis with ascites, 14.3% received an early paracentesis, 7.3% received a late paracentesis, and 78.4% never received a paracentesis. In multivariable modeling, compared with an early paracentesis: both late paracentesis and no-paracentesis were significantly associated with increased odds of acute kidney injury (AKI) development [OR: 2.16 (95% CI, 1.59-2.94) and 1.34 (1.09-1.66), respectively]; intensive care unit (ICU) transfer and 2.01 (1.53-2.69), respectively] and inpatient death [OR: 1.54 (1.03-2.29) and 1.42 (1.05-1.93), respectively]. Nationally, only 14.3% of admitted veterans with cirrhosis and ascites received the American Association for the Study of Liver Diseases (AASLD) guideline-recommended diagnostic paracentesis within 24 hours of admission. Failure to complete early paracentesis was associated with higher odds of AKI, ICU transfer, and inpatient mortality. Universal and site-specific barriers to this quality metric should be evaluated and addressed to improve patient outcomes.

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“…Both of these databases are a part of the healthcare cost and utilization project maintained by the agency for healthcare research and quality. The NIS is an administrative database consisting (until 2012) of all hospitalizations drawn from a sample of 20% of United States hospitals, and then weighted to be nationally representative of all United States hospitalizations[ 12 ]. NRD represents about half of all United States Hospitalizations, and provides a national estimate of readmission rates[ 13 ].…”

Section: Methodsmentioning

confidence: 99%

A retrospective study on use of palliative care for patients with alcohol related end stage liver disease in United States

Gupta¹,

Hans²,

Khan³

et al. 2022

World J Hepatol

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BACKGROUND Palliative care (PC) has been shown to be beneficial in end stage liver disease (ESLD), yet the hospitalization data for PC utilization is unknown. AIM To identify the trend of PC utilization for the special population of alcohol-associated ESLD patients, factors affecting its use and ascertain its impact on healthcare utilization. METHODS We analyzed around 78 million discharges from the 2007-2014 national inpatient sample and 2010-2014 national readmission database including adult patients admitted for decompensated alcohol-associated cirrhosis. We identified patients with PC consultation as a secondary diagnosis. Odds ratios (OR) and means were adjusted for confounders using multivariate regression analysis models. RESULTS Out of the total 1421849 hospitalizations for decompensated liver cirrhosis, 62782 (4.4%) hospitalizations had a PC consult, which increased from 0.8% (1258) of all alcohol-associated ESLD hospitalizations in 2007 to 6.6% in 2014 ( P < 0.01). Patient and hospital characteristics associated with increased odds of PC utilization were advanced age, lower income, Medicaid coverage, teaching institution, urban location, length of stay > 3 d, prolonged ventilation, and administration of total parenteral nutrition (all P < 0.01). Palliative encounters in alcohol-associated ESLD and acute-on-chronic liver failure (ACLF) score were associated with increased odds of discharge to a rehabilitation facility, but significantly lower odds of 30-d readmissions (aOR: 0.35, 95%CI: 0.31-0.41), lower total hospitalization charges and lower mean hospitalization days (all P < 0.01). CONCLUSION Inpatient PC is sparingly used for patients with decompensated alcohol related liver disease, however it has increased over the past decade. PC consultation is associated with lower 30-d readmission rates on multivariate analysis, and lower hospitalization cost and length of stay in patients with ACLF score ≥ 2.

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Weekend admissions with ascites are associated with delayed paracentesis: A nationwide analysis of the ‘weekend effect’

Cited by 7 publications

References 33 publications

Rates of timely paracentesis for patients admitted to hospital with cirrhosis and ascites remain low but are unaffected by the COVID‐19 pandemic

Rates of timely paracentesis for patients admitted to hospital with cirrhosis and ascites remain low but are unaffected by the COVID‐19 pandemic

Early paracentesis is associated with better prognosis compared with late or no-paracentesis in hospitalized veterans with cirrhosis and ascites

A retrospective study on use of palliative care for patients with alcohol related end stage liver disease in United States

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