Comparing outcomes for early and late drainage of malignant ascites.

Abstract

842 Background: Malignant ascites (MA) is a common sequela of peritoneal carcinomatosis resulting in significant morbidity and poses substantial management challenges for clinicians. Large volume paracentesis remains the gold standard treatment. The impact of time to drainage of MA is poorly studied. The purpose of this study was to compare clinical outcomes of hospitalized patients with MA that had drainage performed within 48 hours of admission and after 48 hours of admission. Methods: The NIS was queried between the years 2016 and 2020 to identify all adult patients hospitalized with malignant ascites (ICD-10 code R18.0) and had a drainage procedure performed (ICD-10 Procedure code 0W9Gx). These patients were then stratified into an early cohort (<48 hours after admission) and late cohort (>48 hours after admission). Baseline characteristics and clinical outcomes were collected and analyzed using chi squared tests, independent sample t-tests, and binary logistic regression (adjusted for age, gender, and Charlson comorbidity index or CCI). Adjusted Odds ratios (aOR) are presented with 95% Confidence intervals (CI). Results: A total of 129,040 patients were analyzed, with 89,905 (69.7%) hospitalizations in the early cohort and 39,135 (30.3%) in the late cohort. Baseline characteristics were similar between the groups, with no significant differences in age (63.8 vs 63.6, p = .06) or gender distribution (63.6% vs 63.1%, p = .09). However, patients in the early paracentesis group exhibited a lower CCI (9.8 vs 10.2, p<.001). Notably, early paracentesis was associated with significantly improved outcomes, including lower mortality (aOR 0.67, 95% CI 0.64–0.69), reduced incidence of sepsis (aOR 0.67, 95% CI 0.65–0.69), decreased need for transfusions (aOR 0.69, 95% CI 0.66–0.71), lower rates of mechanical ventilation (aOR 0.44, 95% CI 0.42–0.47) and vasopressor use (aOR 0.79, 95% CI 0.73–0.87). Conclusions: Early paracentesis in patients with malignant ascites was found to be associated with significantly improved clinical outcomes, independent of comorbidity burden. These findings underscore the importance of timely intervention to mitigate complications and enhance quality of life. Late ParacentesisN=39,135 EarlyN=89,905 p-value Age (years) 63.6 ± 13.1 63.8 ± 13.0 .06 Gender (% female) 24665 (63.1%) 57120 (63.6%) .09 CCI 10.2 ± 3.1 9.8 ± 3.2 <.001 Mortality 5720 (14.6%) 9030 (10.0%)aOR .67 (.64 - .69) <.001 Sepsis 7675 (19.6%) 12525 (13.9%)aOR .67 (.65 - .69) <.001 Transfusion 5275 (13.5%) 8605 (9.6%)aOR .69 (.66 - .71) <.001 Ventilation 2130 (5.4%) 2190 (2.4%)aOR .44 (.42 - .47) <.001 Vasopressor 770 (2.0%) 1385 (1.5%)aOR .79 (.73 - .87) <.001