title: Improved survival in a multidisciplinary short bowel syndrome program.
abstract: OBJECTIVE
  Pediatric short bowel syndrome (SBS) remains a management challenge with significant mortality. In 1999, we initiated a multidisciplinary pediatric intestinal rehabilitation program. The purpose of this study was to determine if the multidisciplinary approach was associated with improved survival in this patient population.
  
  
  METHODS
  The Center for Advanced Intestinal Rehabilitation includes dedicated staff in surgery, gastroenterology, nutrition, pharmacy, nursing, and social work. We reviewed the medical records of all inpatients and outpatients with severe SBS treated from 1999 to 2006. These patients were compared to a historical control group of 30 consecutive patients with severe SBS who were treated between 1986 and 1998.
  
  
  RESULTS
  Fifty-four patients with severe SBS managed by the multidisciplinary program were identified. Median follow-up was 403 days. The mean residual small intestinal length was 70 +/- 36 vs 83 +/- 67 cm in the historical controls (P = NS). Mean peak direct bilirubin was 8.1 +/- 7.9 vs 9.0 +/- 7.4 mg/dL in controls (P = NS). Full enteral nutrition was achieved in 36 (67%) of 54 patients with severe SBS vs 20 (67%) of 30 patients in the control group (P = NS). The overall survival rate, however, was 89% (48/54), which is significantly higher than in the historical controls (70%, 21/30; P < .05).
  
  
  CONCLUSIONS
  A multidisciplinary approach to intestinal rehabilitation allows for fully integrated care of inpatients and outpatients with SBS by fostering coordination of surgical, medical, and nutritional management. Our experience with 2 comparable cohorts demonstrates that this multidisciplinary approach is associated with improved survival.
authors.affiliation: Center for Advanced Intestinal Rehabilitation (CAIR), Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Biren P
authors.initials: BP
authors.lastname: Modi
authors.forename: Monica
authors.initials: M
authors.lastname: Langer
authors.forename: Y Avery
authors.initials: YA
authors.lastname: Ching
authors.forename: Clarissa
authors.initials: C
authors.lastname: Valim
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Waterford
authors.forename: Julie
authors.initials: J
authors.lastname: Iglesias
authors.forename: Debora
authors.initials: D
authors.lastname: Duro
authors.forename: Clifford
authors.initials: C
authors.lastname: Lo
authors.forename: Tom
authors.initials: T
authors.lastname: Jaksic
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
mesh_terms: D016022:Case-Control Studies; D003131:Combined Modality Therapy; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010288:Parenteral Nutrition / Q000379:methods*; D010348:Patient Care Team / Q000458:organization & administration*; D011237:Predictive Value of Tests; D011336:Probability; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012778:Short Bowel Syndrome / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013577:Syndrome; D016896:Treatment Outcome