Introduction Intestinal failure (IF) occurs when there is reduced intestinal absorption causing malnutrition and/or dehydration. The management of this condition has changed since the very first patients were started on long-term parenteral support in the form of parenteral nutrition in the 1960s. At our unit our first patient was started on long-term parenteral support in the 1970’s. We now care for the largest number of HPN patients in the UK. We describe changes in aetiology as seen in our unit over the last 36 years.
Method Clinical records of 974 adult patients receiving home parenteral support for IF at our tertiary referral centre were analysed from a period from January 1979 until October 2016. Demographic data including age, sex, underlying aetiology, complication rates and survival was recorded. Difference between groups were analysed by with chi-squared tests, and the Cox’s regression model was used to assess survival.
Results The mean age of patients treated at our unit has increased from 31±16.5 to 52±17.6 years from pre 1989 to 2010–2016. During the same period there has been a change in the underlying aetiology, with a greater percentage of patients with IF due to surgical complications (3.4% to 28.8%% (p<0.001)), fewer with IBD as an underlying cause (37.9% to 22.6%)%) (p<0.001) and malignancy now forming a proportion of our patient cohort (0% to 8.4%)%). IF related complications have reduced with significant change in percentage of patients with catheter related blood-stream infections (71.4% to 42.2%)%) (p<0.005) and central venous catheter associated thrombosis (36% to 5.3%)%) (p<0.001). Associated with these findings overall survival was better in the pre 1995 era HR 0.2–0.4 (p=0.02).
Conclusion At our institution there has been a significant change in the underlying aetiology and demographics of patients with IF. The age of initiation of home parenteral support is increasing, and there has been a reduction in the proportion of patients with IBD as the underlying cause of IF with an increase in surgical complications and malignancy. Our data also shows that there has been a reduction in the rates of complications related to IF including catheter related blood stream infection rates and rates of central venous thrombosis. Notably survival outcomes were significantly better in the period pre 1995, which is likely explained by the fact that we now are treating older patients with complex underlying conditions associated with poorer outcomes.
Disclosure of Interest None Declared
- Intestinal failure