The role of surgery in weaning patients from home parenteral support – a cohort study

McKee, R. F., Knight, K., Leitch, E. F. and Stevens, P. (2022) The role of surgery in weaning patients from home parenteral support – a cohort study. Colorectal Disease, 24(5), pp. 621-630. (doi: 10.1111/codi.16066) (PMID:35066961)

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Background: Some patients with intestinal failure requiring Home Parenteral Support (HPS) may be weaned. This study considers all abdominal surgery in a cohort of HPS patients over 25 years. The aim was to identify how many patients can be weaned from HPS and by what means, and to identify what makes weaning more likely. Methods: A prospectively collected database of HPS patients to December 2018 was analysed for outcomes of care. Results: At five years 56% of 205 patients remained on HPS. Fifty-eight patients(28%) who had 68 operations, stopped HPS after surgery. Patients stopping HPS had longer median final small bowel length (155cm; range 45-350cm) and were more likely to have colon in circuit (84%) than patients who had reconstructive surgery but did not stop HPS (median small bowel length 50cm; range 15-135cm; 50% colon in circuit). The median period between HPS discharge and reconstructive surgery was 238 days. There were no deaths but 18 Clavien-Dindo Grade 3/4 complications within 30days. 90% of patients who stopped HPS survived 5 years from the start of HPS in comparison to 53% of those who remained on HPS. Conclusions: No previous study has examined surgery in an entire cohort of HPS patients. More than one quarter of HPS patients can be weaned after reconstructive surgery. The length of bowel available for recruitment at surgery is the main determinant of ability to stop HPS. The possibility of reconstruction should be considered, since patients who stop HPS appear to have a survival advantage.

Item Type:Articles
Glasgow Author(s) Enlighten ID:McKee, Dr Ruth and Knight, Miss Katrina
Creator Roles:
McKee, R.Conceptualization, Data curation, Writing – original draft, Writing – review and editing
Knight, K.Data curation, Writing – review and editing
Authors: McKee, R. F., Knight, K., Leitch, E. F., and Stevens, P.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Colorectal Disease
ISSN (Online):1462-8910
Published Online:23 January 2022
Copyright Holders:Copyright © 2022 Association of Coloproctology of Great Britain and Ireland
First Published:First published in Colorectal Disease 24(5): 621-630
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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