Introduction HIFNET proposals to create regionalised services for intestinal failure (IF) in England led us in 2007 to start active development of our small pre-existing regional IF activities and consequent expansion of our IF network. We report our outcomes compared to other published data.
Methods Data were retrospectively collected from electronic and paper records for adult patients who received HPN between January 2001 and October 2011.
Results Data were available for 79/81 patients (45 female) who received HPN for a period of 160 patient-years. 45 (57%) patients were regional referrals, 21 (27%) patients had type 2 intestinal failure and 58 (73%) type 3. The total number of patient-days in 2011 was 11 787 (type 2 2748, type 3 9039) compared to 4524 in 2007 (type 2 60, type 3 4464), despite only 10 months of 2011 data available at time of data collection. The period prevalence of patients on HPN in 2011 was 42 compared to 11 in 2007, a 381% increase. The median duration patients were treated was 230 days in 21 type 2 patients and 712 days in 47 type 3 (excluding palliative HPN), with on-going treatment in 37 patients. The rate of catheter related sepsis was 1.16 per 1000 patient days, comparable to 0.86 per 1000 patient days reported by one national centre.1 The line occlusion rate was 0.27 per 1000 patient days and no episodes of bacterial endocarditis, similar to data from another regional unit, 0.68 per 1000 days and 0.05 per 1000 days respectively.2 There were eight deaths (excluding palliative HPN), of which three were liver complications of type 3 IF in patients who were either ineligible or declined transplantation.
Conclusion These data demonstrate a significant increase in HPN activity, particularly the last 5 years and the need for regional IF centres to cope with previous limited national capacity. Despite this increase in demand, quality outcome measures were comparable with those from other regional and nationally funded units.
Competing interests None declared.
References 1. Green CJ, Mountford V, Hamilton H, et al. A 15-year audit of home parenteral nutrition provision at the John Radcliffe Hospital, Oxford. QJM 2008;101:365–9.
2. Lloyd DA, Vega R, Bassett P, et al. Survival and dependence on home parenteral nutrition: experience over a 25-year period in a UK referral centre. Aliment Pharmacol Ther 2006;24:1231–40.