Long-Term Abdominal Drains in Refractory Ascites Due to Cirrhosis: A Retrospective Cohort Analysis

Refractory ascites in cirrhosis presents major management challenges and is associated with frequent hospital admissions, reduced quality of life, and poor survival. Long-term abdominal drains (LTADs) have emerged as a palliative alternative to repeated large-volume paracentesis (LVP), yet real-world outcome data remain limited.

We performed a retrospective analysis of 44 patients with cirrhosis and refractory ascites who underwent LTAD insertion between 2019 and 2024 at a district general hospital. Clinical outcomes, including survival, complication rates, hospital admissions, and length of stay (LOS), were evaluated. Data were analysed using Kaplan-Meier survival curves and descriptive statistics for pre- and post-LTAD comparisons.

Median survival after LTAD was eight months; Kaplan-Meier estimated 12-month survival was 65%. LTAD insertion was associated with a 47% reduction in hospital admissions and a 55% reduction in cumulative LOS in the six months post-procedure compared to the six months pre-procedure. Specifically, admissions dropped from 102 to 54, and LOS from 1,150 to 520 days for the cohort. Spontaneous bacterial peritonitis (SBP) occurred in 18% of patients and catheter-related infections in 11%. Ascitic fluid leakage was observed in 20% and drain blockage in 14%. No procedure-related mortality was identified.

LTADs represent a safe and effective palliative strategy for managing refractory ascites in cirrhosis. They significantly reduce healthcare utilisation while maintaining acceptable complication rates. Careful patient selection and multidisciplinary management are essential to optimise outcomes. LTADs are currently a case-by-case palliative option, but ongoing trials will further clarify their role. Prospective studies are warranted to validate these findings and to assess quality-of-life improvements.