A175 HOME PARENTERAL NUTRITION (HPN): INDICATIONS FOR THERAPY AND OUTCOMES FOR PATIENTS IN A SINGLE-CENTRE, CANADIAN HPN PROGRAM (1996–2018)

Abstract Background Parenteral nutrition (PN) is a life-sustaining therapy for patients who are unable to maintain adequate oral or enteral nutritional intake; for patients who do not require additional, intensive medical therapy, home PN (HPN) offers a cost-effective option for long-term nutritiona...

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Published in:Journal of the Canadian Association of Gastroenterology 2019-03, Vol.2 (Supplement_2), p.344-345
Main Authors: Mangat, R, Hansen, S, Plant, J, Pinto-Sanchez, M I, Armstrong, D
Format: Article
Language:English
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Summary:Abstract Background Parenteral nutrition (PN) is a life-sustaining therapy for patients who are unable to maintain adequate oral or enteral nutritional intake; for patients who do not require additional, intensive medical therapy, home PN (HPN) offers a cost-effective option for long-term nutritional support. The indications for HPN vary markedly in different centres, in part due to concerns regarding the outcomes for patients who have an incurable underlying diagnosis. Aims To evaluate the indications for HPN and patient outcomes in a single-centre, HPN program with respect to the patients’ underlying diagnosis. Methods A registry of all patients referred to a single-centre for consideration of HPN over a 22-year period was analysed to determine the numbers of patients who started HPN, the indication for HPN, the duration of HPN therapy and patient survival. Descriptive statistical analyses were performed. Results From 1996 to 2018, 849 patients were referred for HPN; of these, 479 (56%) patients (292F, 187M) started HPN. The mean age at the start of HPN was 51.2 yrs (SD: 15.2); the median duration of HPN was 103 days (IQR: 43–246). The primary reasons for starting HPN were: intestinal obstruction (176: 34.6%), fistula (124: 24.4%), short bowel syndrome [SBS] (120: 23.6%), intestinal dysmotility (44: 8.7%), intestinal mucosal disease (19: 3.7%) and others (25: 4.9%). Patients receiving HPN for bowel obstruction or fistulizing disease (bowel rest) were, generally, older and the median duration of HPN therapy was significantly lower for these patients (Table). SBS patients had the longest duration of HPN; 44 of 120 (35.7%) SBS patients died on HPN or within 1 month of stopping (age at start: 55.7 (SD: 14.8) yrs; median HPN duration: 516 (IQR: 177–1063) days); of the 76 remaining SBS patients, 17 continue HPN (age at start: 51.7 (SD: 15.6) yrs; median HPN duration: 840 (IQR: 243–1821) days). Conclusions Over 40% of patients considered for HPN can be managed, solely, by optimisation of their oral and enteral intake of food and nutrients. For those patients who started HPN, the median treatment duration was greater than 3 months. Short-term HPN (median 2–3 months) was sufficient to support patients requiring bowel rest (obstruction, fistulae) but patients with intestinal failure (SBS, dysmotility) required HPN for longer periods (median 7–14 months) and many SBS patients currently require permanent HPN to survive. Reason for HPN Condition Cases Age [yrs]: Mean
ISSN:2515-2084
2515-2092
DOI:10.1093/jcag/gwz006.174