A 15-year audit of home parenteral nutrition provision at the John Radcliffe Hospital, Oxford.
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.


OBJECTIVE
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.


METHODS
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.


CONCLUSIONS
HPN can be delivered effectively outside designated intestinal failure units and the current data are representative of a standard of care.
Green
C J
CJ
Department of Gastroenterology, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK. carolinegreen@doctors.net.uk
Mountford
V
V
Hamilton
H
H
Kettlewell
M G W
MG
Travis
S P L
SP
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004739:England; D004812:Epidemiologic Methods; D005260:Female; D006297:Health Services Accessibility; D018575:Home Care Services, Hospital-Based / Q000592:standards*; D006801:Humans; D007410:Intestinal Diseases / Q000628:therapy*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000592:standards*; D011787:Quality of Health Care