Introduction Malignancy-related ascites (MRA) carries significant morbidity and mortality, and is usually treated by large volume paracentesis (LVP). There are no local guidelines. LVP occurs via Medical Ambulatory Care (MAC). An indwelling peritoneal catheter (IPC) service exists for recurrent ascites. We hypothesised that analysis of patients with MRA requiring LVP would allow protocol development.

Methods A retrospective analysis of patients requiring LVPs for MRA on MAC between Oct 2018 and Dec 19 was performed with local Caldicott approval. Demographics and outcomes were collected. Descriptive statistical methodology was applied with continuous data presented as mean (standard deviation (SD); range) and categorical variables as frequencies or percentages.

Results 27 patients were identified {Mean age 68.5 yrs (SD±11.85; range: 41–86); 55.5% female}. Rockwood Clinical Frailty Score was recorded in 18: 1=7.4%, 2=18.5%, 3=14.8%, 5=7.4%. All patients had at least 2 admissions in the preceding 12 months (mean 5.5 (SD±2.76; 2–15). Diagnoses were GI (55.5%), ovarian (25.9%), unknown primary (11.1%), breast (3.7%), and neuroendocrine cancers (3.7%). 92% had metastatic disease, 55% peritoneal metastases. Presenting symptoms were abdominal swelling/bloating/distension (100%), abdominal pain (22%) and shortness of breath (11%). 40.7% of were readmitted within 30 days for drainage. 37% were referred and had an IPC. Mean time from first LVP to death was 58.18 days (SD±54.00; 7–210). 66% of patients had a sample sent for analysis. 38.88% had positive cytology. 5 samples had biochemical analysis: 4 were transudative (all negative cytology); 1 was exudative (positive cytology). No patients developed hypotension with LVP. 1 patient with transudative MRA developed bacterial peritonitis.

Conclusions This is the first study to determine epidemiological local data on the foregoing. There is clear variance in practice. We suggest that all samples should have biochemical analysis (transudates are to be given prophylactic antibiotics) and all patients should be referred for consideration of IPC.