65. Pyogenic liver abscess outpatient outcomes following hospitalization and intervention: Single-center experience 2007-2012
Session: Oral Abstract Session: Bacterial Diseases
Thursday, October 8, 2015: 9:15 AM
Room: 25--ABC
Background:

Pyogenic liver abscesses (PLA) are increasingly managed by percutaneous drainage (PD) instead of surgery, with good inpatient (inpt) results. The intensity of post-discharge (d/c) care and factors predicting poor outcomes (ED visits (ED), readmissions (RA), and mortality) have not been described.

Methods:

This was a retrospective, descriptive case series. With IRB approval, we used ICD-9 code 572.0 to identify patients (pts) treated at DHMC, a regional academic tertiary center, for PLA from 2007-2012. We reviewed charts for clinical features and inpt/outpt outcomes. Data for care received at other facilities was not available. Pts were compared by presence of malignancy (CA) and ED/RA.

Results:

There were 164 PLA admissions (125 unique pts). Of 125 index admissions, there were 12 surgical drainage (SD), 23 percutaneous aspiration (PA), 78 PD, 11 no drainage (ND), and 1 was CMO. 77 (62%) were d/c with a drain. 31 (25%) were d/c on IV ABX. There were 71 ED visits (57%), 67 30-day RA (54%), and 54 31-90-day TA (43%). Complication rates from ABX (11%) or PICC lines (3%) were low. At 120 days from first d/c, 5 pts (4%) had died. CA predicted ED/RA (table):


Risk factors for 90 day post-discharge ED/RA among patients with PLA: Univariate analysis


 

 

 

Without ED/RA

(all cause)

(n=60)

With ED/RA

(all cause)

(n=65)

P value

Age, mean (range)

61 (23-92)

61 (13-91)

0.995

Comorbidities, #(%)

Malignancy (CA)

Biliary disease

18 (28)

13 (22)

42 (63)

23 (35)

0.0001

0.0906

Inpt intervention, #(%)

SD

PA

PD

ND

4 (7)

13 (22)

38 (63)

4 (7)

8 (12)

10 (15)

40 (62)

7 (11)

0.5108

Abscess size >5 cm, (mean) (n=54 total pts)

27 (50)

27 (50)

0.3552

Micro unknown, # (%)

11 (18)

12 (18)

0.9853

D/c IV ABX, # (%)

14 (23)

16 (26)

0.7153

D/c with drain, # (%)

30 (50)

40 (62)

0.1942

Length of stay <5 D, # (%)

24 (40)

20 (31)

0.2803

 

 

 

 

Length of ABX <30 D, # (%)

27 (45)

25 (38)

0.4587

F/u appts, < 3 within 90 D, mean (%)

30 (50)

32 (49)

0.9315

Conclusion:

PLA pts have intense oupt care needs and high rates of ED/RA. While PD provides source control without surgery, oupt needs are now more complex, requiring collaboration for drain management. Our data suggests that pts with CA are at higher risk of ED/RA than those without and raises new questions about optimal duration of drain placement, imaging follow-up, and ABX.

Megan Gallagher, MD1 and Mary-Margaret Andrews, MD1,2, (1)Dartmouth-Hitchcock Medical Center, Lebanon, NH, (2)Geisel School of Medicine at Dartmouth, Hanover, NH

Disclosures:

M. Gallagher, None

M. M. Andrews, None

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