P153 Tunnelled long-term abdominal drain (LTAD) for palliation of refractory ascites in end-stage liver disease: a secondary care experience

<h3></h3> Long-term abdominal drain (LTAD) is emerging as an alternative strategy to regular large volume paracentesis (LVP) for the palliation of refractory ascites in end-stage liver disease. The effectiveness of LTAD to reduce dependence on hospital care and improve health-related quality of life is being evaluated in a national trial involving predominantly tertiary centres. We report our 5-year experience of providing this service in a district general hospital setting. A retrospective observational study evaluated the efficacy of tunnelled Rocket peritoneal drain (Rocket Medical, UK) insertion in patients with refractory ascites from liver cirrhosis followed up between April 2020 and May 2025. Malignancy-related ascites was excluded. Electronic patient records were searched for patient- and procedure-related variables. Ambulatory encounters and hospital admissions data post-LTAD insertion were collected. Data is presented as median (IQR) or percentages. Thirty-one patients [age 68 (64–73), 71% male, UKELD score 56 (51–58)] had 36 LTAD inserted mostly as inpatient (67%). Alcohol-related liver disease (71%) was the main aetiology. Minor immediate post-insertion complication occurred in 4 patients (3 leaks, 1 minimal bleeding). SBP prophylactic antibiotic was prescribed post-insertion in 14 patients (45%). The median time to first LTAD-related hospital admission or ambulatory encounter was 32 (7–71) days. Nineteen patients had a total of 47 all-cause hospital admissions within 26 (14–85) days post-insertion. Sixteen patients (52%) had 25 LTAD-related admissions (9 SBP, 5 local site infection, 3 additional paracentesis, 3 leaks, 2 dislodged, 2 blocked, 1 incorrect connectors). The length of stay was 7 (3–11) days. Seven patients (23%) had 9 LTAD-related ambulatory presentations (4 additional paracentesis, 2 leaks, 1 accidental tube damage, 1 incorrect connectors, 1 LTAD re-insertion). SBP occurred within 35 (28–90) days post-insertion in 9 patients, of which, 5 were not on prophylactic antibiotics. There was no difference in SBP occurrence with or without prophylactic antibiotics (p=0.6). LTAD was removed in 8 patients (3 dislodged, 2 local infection, 1 SBP, 1 loculated ascites, 1 damaged tube) and was re-inserted in 5. Twenty-two patients (71%) died within 47 (33–112) days of LTAD insertion. There was a high incidence of secondary care health resource utilisation within a month of insertion in over half the patients. Routine prophylactic antibiotics did not reduce SBP in this small cohort. A more resilient community nursing pathway supported by standard operating procedures to empower symptom-driven palliation in the community is required given the significantly reduced life expectancy in this patient group.