Introduction The aim of this study was to establish the number of patients in whom surgery led to Home Parenteral Nutrition (HPN) in comparison to the number in whom surgery led to stopping HPN.
Methods Data relating to HPN patients has been collected prospectively in our hospital since 2000 as part of the Scottish Managed Clinical Network for HPN. Data held include demographics, underlying disease, previous surgery, and start and stop dates for HPN with the underlying reasons. This data was analysed in January 2011.
Results Sixty eight patients (26M: 42F; median age at start 53 years: range 16–78 years) had HPN supervised by our hospital during 11 years. The underlying disease was Crohn's disease in 26 patients, mesenteric ischaemia in 12 patients, malignancy in seven patients, motility disorders in eight patients, radiation enteritis in seven patients and other in 13 patients. Seven patients started HPN prior to 2000. Between 2000 and 2011, 61 patients started HPN and 35 patients stopped. Forty-three patients started HPN following gastrointestinal surgery and in 20 of these, HPN was needed because of a surgical complication (nine small bowel fistulae; 10 intra-abdominal sepsis leading to high output stoma; one bowel obstruction). Thirty-five patients stopped HPN. Seventeen patients died – nine of the underlying disease, four of unrelated cause, two of HPN complications and two of both HPN complications and the underlying disease. Seventeen patients stopped HPN after reconstructive surgery, HPN was stopped due to complications/lack of progress in one patient and one patient stopped HPN because of more effective medical treatment. Three other patients reduced their dependence on HPN after surgery (fewer nights per week or lower volume). Of the twenty patients who had HPN because of surgical complication, ten patients stopped HPN because of further surgery, five patients have ongoing HPN with no intention for further surgery, two patients have died (one of the underlying malignancy and the other of unrelated cause) and three patients are likely to have reconstructive surgery in the future. None of the patients who came to reconstructive surgery after a period of HPN died after their surgery.
Conclusion Although the complications of surgery may lead to home parenteral nutrition, surgery may also be useful in reconstruction of the GI tract and this may lead to stopping HPN. It is important that surgeons are involved in the care of HPN patients, as they may be more conscious of the possibility of reconstruction.
Competing interests None declared.
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