A 15-year audit of home parenteral nutrition provision at the John Radcliffe Hospital, Oxford.
Green CJ., Mountford V., Hamilton H., Kettlewell MGW., Travis SPL.
BACKGROUND: Home parenteral nutrition (HPN) is an established option for patients suffering from intestinal failure, often pending definitive surgery, but sometimes for life or pending intestinal transplant. Care for patients with HPN is provided at centres other than designated intestinal failure units in the UK, but there are few data on outcomes. AIM: To audit the standard of care at one such centre using objective measures to compare with results published from other centres and intestinal failure units. DESIGN: 15-year retrospective audit of paper and computer-based records of all HPN patients (1990-2004). METHODS: Demographic data, major line and metabolic complication rates and mortality were collected and analysed. RESULTS: 88 patients received HPN for a total period of 121 patient-years (median duration 217.8 days, range 18.3-3881.2, median age 40, range 3-73). Principal reasons for HPN were Crohns' disease (35.2%), mesenteric, infarction (11.4%), surgical complications (17.0%), intestinal motility disorder (10.7%). The frequency of major complications were line sepsis (0.35 episodes/patient-year), line occlusion (0.25 episodes/patient-year), subacute bacterial endocarditis (0.02 episodes/patient-year), cholestasis (0.17 episodes/patient-year) and central venous thrombosis (0.03 episodes/patient-year). Indications and complications were all within the range of published data. CONCLUSION: HPN can be delivered effectively outside designated intestinal failure units and the current data are representative of a standard of care.