title: Permanent catheters for recurrent ascites-a critical and systematic review of study methodology.
abstract: Management of refractory ascites traditionally includes medical treatment with diuretics or intermittent paracentesis. Patients with recurrent ascites may benefit from the use of permanent intra-abdominal catheters with more frequent drainage without hospitalization. The objective was to systematically asses the methodology of factors and endpoints reported in studies investigating permanent catheters for recurrent ascites treatment.
  
  
  
  Using a systematic search strategy, we critically assessed the methodology when treating refractory ascites using a permanent catheter. Studies critically assessed included both retro- and prospective studies.
  
  
  
  A total of 715 unique articles were found via PubMed, The Cochrane Library and Embase. Twenty-nine studies (tunnelled catheter = 12, peritoneal ports = 6 and peritoneovenous shunts = 11) with three distinct types of permanent catheters fulfilled the inclusion criteria. Only three studies reported technical success less than 100 %. Data on complications and treatment were not available in all papers; peritonitis (48 %), cellulitis (41 %), prophylactic antibiotics (48 %) and complications to catheter insertion were difficult to distinguish from advanced co-morbidity of patients. Thirteen studies (45 %) reported some type of evaluating patient experience or functional outcome, but only three studies used validated reproducible scales when assessing outcomes. Fifteen of the 29 studies included 30 patients or less.
  
  
  
  Knowledge is limited because complications and outcomes are poorly defined. The expected increase in catheter treatment of refractory ascites necessitates comparative studies, using validated patient-related outcomes, and the reporting of unambiguous complications. A proposal of variables to include in future studies is presented.
authors.affiliation: Department of Anaesthesiology, Slagelse Hospital, Fælledvej 1, 4200, Slagelse, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Christensen
authors.affiliation: Royal School of Library and Information Science, Faculty of the Humanities, Copenhagen University, Birketinget 6, 2300, Copenhagen S, Denmark.
authors.forename: Lorna
authors.initials: L
authors.lastname: Wildgaard
authors.affiliation: Department of Anaesthesiology, Slagelse Hospital, Fælledvej 1, 4200, Slagelse, Denmark. wildgaard@kejsersnit.com.|Department of Anaesthesiology, Næstved Hospital, Ringstedgade 40, 4700, Næstved, Denmark. wildgaard@kejsersnit.com.
authors.forename: Kim
authors.identifier: 0000-0001-7084-9200
authors.initials: K
authors.lastname: Wildgaard
mesh_terms: D001201:Ascites / Q000628:therapy*; D002408:Catheters, Indwelling / Q000009:adverse effects; D006801:Humans; D019152:Paracentesis / Q000009:adverse effects / Q000379:methods*
keywords: Diuretics; Intermittent paracentesis; Permanent catheters; Refractory ascites