Outcomes following nurse-led day-case paracentesis

BACKGROUND: Refractory ascites is a frequent complication of decompensated cirrhosis. Therapeutic paracentesis (TP) is a key intervention for symptom relief and as a bridge to definitive treatment. In response to rising demand, Nottingham University Hospitals NHS Trust was among the first UK centres to introduce a nurse-led, day-case TP service. However, long-term morbidity and mortality outcomes remain underreported. This study evaluates the complications and mortality associated with this service. METHODS: A retrospective analysis was undertaken of all patients with decompensated cirrhosis who underwent nurse-led day-case TP between 1 January 2017 and 31 December 2021. Demographic, clinical, and outcome data, including detailed complication records, were systematically collected.RESULTS: Over the 5-year study period, a total of 2,530 TP procedures were performed on 340 patients. Minor complications occurred in 54 cases (2.1%), all of which were self-limiting and required minimal intervention. In 22 cases (0.8%), patients were admitted to hospital within seven days of the procedure – the reasons for admission were bacterial peritonitis (n=11), leakage of ascitic fluid from the puncture site (n=7), post-procedure abdominal pain (n=3), and bleeding from the puncture site (n=1). There were no cases of abdominal visceral perforation or in-hospital deaths among those admitted following TP.Of the 290 patients included in the one-year survival analysis, 177 (61%) were alive one year after their first TP. The median time from first TP to death was 125 days (IQR 43–210). The 30- and 90-day mortality rates a TP were 21.0% and 33.1%, respectively. Older age (p<0.001), hepatocellular carcinoma (p<0.001) and ongoing alcohol use (p<0.001) were independently associated with one-year mortality, following Bonferroni correction for statistical significance.CONCLUSION: Nurse-led, day-case therapeutic paracentesis is an effective and safe approach for managing refractory ascites in decompensated cirrhosis, with a low rate of procedure-related complications. However, mortality remains high, particularly in patients with hepatocellular carcinoma and ongoing alcohol use, highlighting the need for comprehensive multidisciplinary care to improve outcomes in this high-risk group.