Home parenteral nutrition (HPN) treatment duration: implications for HPN team resource planning

Ramandeep Mangat, Author, Medicine, McMaster University, Hamilton, Ontario, L8S 4K1Presenting Author

Suzanne Hansen, Coauthor, Digestive Diseases, Hamilton Health Sciences Corporation, Hamilton, Ontario, L8S 4K1

Jane Plant, Coauthor, Digestive Diseases, Hamilton Health Sciences Corporation, Hamilton, Ontario, L8S 4K1

Maria Ines Pinto Sanchez, Coauthor, Medicine, McMaster University, Hamilton, Ontario, L8S 4K1

David Armstrong, Coauthor, Medicine / Farncombe Instititute, McMaster University, Hamilton, Ontario, L8S 4K1

Background: Parenteral nutrition (PN) is life-saving for intestinal failure (IF) patients; many require only short-term, inpatient PN but those who require longer-term PN may remain in hospital, solely to receive PN. HPN offers long-term PN in the community for a variety of indications, including short bowel syndrome (SBS), gastrointestinal (GI) mucosal disease (MD), dysmotility (DM), enteric fistulae (EF) and GI obstruction (GO). However, HPN is resource-intensive and resource planning for HPN teams is hampered by uncertainty regarding the duration and intensity of IF therapy.

Aims: To evaluate predictors of treatment duration in IF patients in a tertiary-care Canadian HPN program.

Methods: We reviewed all patients in a single-site HPN program from July 1996 to December 2019 to document patient age, sex, diagnosis and HPN duration. Descriptive statistical analyses and Mann-Whitney U test were performed.

Results: There were 492 HPN program admissions (299F, 193M; mean age 51.5); indications for included SBS (119), DM (42), MD (35), EF (120) and GO (176). Diagnoses leading to SBS included inflammatory bowel disease (36.1%), intestinal ischemia (26.1%), cancer (20.2%), surgical-related complications (16.0%) and other (4.2%). Overall, 75% of SBS patients with received HPN for >98 days and 25% received HPN for >1056 days. SBS patients received HPN for a significant longer period than other patients (median 368 vs 83 days, p < 0.00001). Patients with SB50 cm (median 590 vs 310 days). The proportions of patients requiring HPN after 3, 6, 12 and 24 months for different HPN indications were, respectively: SBS (%): 82.4, 63.0, 50.4, 37.0; DM (%): 76.2, 54.8, 38.1, 31.0; MD (%): 51.4, 42.9, 22.9, 11.4; EF (%): 41.7, 20.0, 2.5, 1.7; GO (%): 45.5, 18.8, 7.4, 4.0.

Conclusions: Over 80% of SBS patients require HPN for >3 months and 40% require HPN for >2 years; conversely, only 20% of EF and GO patients require HPN for >6 months, However, SBS patients constitute only about 25% of HPN patients. These data may assist in resource planning for developing HPN teams to care for IF patients in the community.