RESUMEN
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.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Ascitis/cirugía , Neoplasias Ováricas/complicaciones , Neoplasias Ováricas/economía , Paracentesis/efectos adversos , Paracentesis/economía , Adulto , Anciano , Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Procedimientos Quirúrgicos Ambulatorios/economía , Ascitis/diagnóstico por imagen , Ascitis/economía , Ascitis/etiología , Análisis Costo-Beneficio , Manejo de la Enfermedad , Estudios de Factibilidad , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Londres , Registros Médicos , Persona de Mediana Edad , Cuidados Paliativos/métodos , Paracentesis/métodos , Seguridad del Paciente , Radiografía , Estudios Retrospectivos , Resultado del Tratamiento , Reino UnidoRESUMEN
INTRODUCTION: Sedation of children for short painful procedures is increasingly performed in emergency departments as an alternative to hospital admission and theatre. In this study, the savings of this are sought to be quantified. METHODS: A matched-cohort economic evaluation was conducted. Detailed case note reviews were performed on children who were sedated in the emergency department and children who were admitted to theatre. The costs of these were compared. RESULTS: 17 children underwent sedation in our emergency department and were compared with 20 children admitted to theatre. Each emergency department sedation saved £614 (95% CI £441 to £787), and this result was statistically significant (p<0.0001). CONCLUSION: Emergency department sedation offers considerable savings, compared with theatre-based management for children who require short painful procedures.