Transformation of indwelling peritoneal catheter placement for malignant ascites from an inpatient to a day-case service: analysis of patient risk and financial implication

• Published in: Clinical radiology Vol. 77; no. 9; pp. 689 - 693
• Main Authors: Daga, K., Berry, T., Mullan, D., Laasch, H.-U.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.09.2022
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/j.crad.2022.05.027

To investigate the impact on patient outcomes, costs, and resources/infrastructure of inserting indwelling peritoneal catheters (IPC) during a day-case instead of an inpatient service. A single-centre, retrospective analysis of patients receiving IPCs over a 4-year period was performed. Patients undergoing a day-case procedure were admitted in the morning for pre-procedural investigations, a 15.5 F PleurX IPC (BD, Wokingham, UK) was inserted, all accessible fluid drained and patients discharged the same day, barring any complications. Using electronic patient records, outcomes and complications (immediate/post-procedural) were recorded. Expenses and re-imbursement tariffs were obtained from the income department. Of 138 IPC procedures, 45.6% were undertaken after formal inpatient admission, 54.3% were undertaken as a day-case. The mean hospital stay was 2.51 bed-days for inpatient procedures (n=63) and 0.31 bed-days for day-case procedures (n=75; p<0.001). Day-case procedures saved 165 bed-days per year. Complication rates were 15.9% and 16% for inpatient and day-case procedures respectively (p=0.98). There was an estimated savings of £1,850.46 per day-case procedure or £138,784.50 annually. The placement of IPCs can safely be performed as a day-case procedure. There were substantial economic benefits as well as improved patient satisfaction, with no compromise in patient outcomes. Day-case IPC insertion is now standard practice at The Christie NHS Trust. •Indwelling peritoneal catheters are an established solution for malignant ascites.•Converting IPC insertion from inpatient to daycase saves costs and resources.•Daycase IPC insertions do not adversely affect patient safety or complication rates.•Patients receiving daycase insertions had greater survival than inpatient cohorts.