Introduction Long-term abdominal drains (LTADs) prevent ascites build-up, improve quality of life (QOL) and reduce hospital admissions for patients with refractory ascites. In NHS Grampian patients with decompensated end-stage liver disease (ESLD) not suitable for transplant or TIPSS are offered an informed choice between repeated large-volume paracentesis (LVP) and LTAD. In NHSG, LTADs are inserted by Palliative Medicine physicians.
Methods • Retrospective data collection/analysis for ESLD patients who underwent LTAD insertion in NHSG between 2020–2022.
Results 23 ESLD patients underwent LTAD insertion. 8 further patients were referred for LTAD but died before insertion. In the 3 months prior to LTAD, patients had an average of 3 admissions for LVP (range 1–6). The mean number of days between LTAD insertion and death was 59 (range 7–320). LTAD insertion prevented a mean of 2 further admissions for LVP per patient (range 0–10). 74% had no complications and either had LTAD in until death, or are still alive. 2 patients (9%) had infections; 1 resolved with antibiotics, 1 required drain removal. 4 patients (15%) accidentally had their LTADs pulled out or damaged. Prior to LTAD, 65% of patients had no evidence of advance care planning (ACP). Post-LTAD, 74% of patients had an improvement in documented ACP. Only 17% of patients died in an acute hospital, the majority dying at home or in a palliative care unit or community hospital.
Conclusion The majority of patients had no complications from LTAD and it remained in situ until death, reducing hospital admissions and allowing more time at home. 74% had improvement in ACP documentation after LTAD insertion, and only 17% of patients died in an acute hospital, compared to the national figure of 73%. Having Palliative Medicine physicians running the LTAD service allows early introduction of Palliative Care for decompensated ESLD patients and offers the opportunity for holistic assessment and ACP discussions.
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