title: Home enteral nutrition reduces complications, length of stay, and health care costs: results from a multicenter study.
abstract: BACKGROUND
  Home enteral nutrition (HEN) has always been recognized as a life-saving procedure, but with the ongoing economic crisis influencing health care, its cost-effectiveness has been questioned recently.
  
  
  OBJECTIVE
  The unique reimbursement situation in Poland enabled the otherwise ethically unacceptable, hence unavailable, comparison of the period of no-feeding and long-term feeding and the subsequent analyses of the clinical value of the latter and its cost-effectiveness.
  
  
  METHODS
  The observational multicenter study in the group of 456 HEN patients [142 children: 55 girls and 87 boys, mean (±SD) age 8.7 ± 5.9 y; 314 adults: 151 women and 163 men, mean age 59.3 ± 19.8 y] was performed between January 2007 and July 2013. Two 12-mo periods were compared. During the first period, patients were tube fed a homemade diet and were not monitored; during the other period, patients received HEN. HEN included tube feeding and complex monitoring by a nutrition support team. The number of complications, hospital admissions, length of hospital stay, biochemical and anthropometric variables, and costs of hospitalization were compared.
  
  
  RESULTS
  Implementation of HEN enabled weight gain and stabilized liver function in both age groups, but it hardly influenced the other tests. HEN implementation reduced the incidence of infectious complications (37.4% compared with 14.9%; P < 0.001, McNemar test), the number of hospital admissions [1.98 ± 2.42 (mean ± SD) before and 1.26 ± 2.18 after EN; P < 0.001, Wilcoxon's signed-rank test], and length of hospital stay (39.7 ± 71.9 compared with 11.9 ± 28.5 d; P < 0.001, Wilcoxon's signed-rank test). The mean annual costs ($) of hospitalization were reduced from 6500.20 ± 10,402.69 to 2072.58 ± 5497.00.
  
  
  CONCLUSIONS
  The study showed that HEN improves clinical outcomes and decreases health care costs. It was impossible, however, to determine precisely which factor mattered more: the artificial diet itself or the introduction of complex care.
authors: From Stanley Dudrick's Memorial Hospital, General and Oncology Surgery Unit, Skawina, Poland (SK, KS, and PS); the Department of Pediatric Surgery, Medical University of Bialystok, Bialystok, Poland (AH); the Home Enteral Nutrition Unit, Stomed, Ostroleka, Poland (GD); Gastroenterology and Oncology and Plastic Surgery, Medical University of Poznan, Poznan, Poland (KM); and Jagiellonian University Medical College, Chair of Epidemiology and Preventive Medicine, Department of Epidemiology, Krakow, Poland (AG).
authors: Stanislaw
authors: S
authors: Klek
authors: From Stanley Dudrick's Memorial Hospital, General and Oncology Surgery Unit, Skawina, Poland (SK, KS, and PS); the Department of Pediatric Surgery, Medical University of Bialystok, Bialystok, Poland (AH); the Home Enteral Nutrition Unit, Stomed, Ostroleka, Poland (GD); Gastroenterology and Oncology and Plastic Surgery, Medical University of Poznan, Poznan, Poland (KM); and Jagiellonian University Medical College, Chair of Epidemiology and Preventive Medicine, Department of Epidemiology, Krakow, Poland (AG).
authors: Adam
authors: A
authors: Hermanowicz
authors: From Stanley Dudrick's Memorial Hospital, General and Oncology Surgery Unit, Skawina, Poland (SK, KS, and PS); the Department of Pediatric Surgery, Medical University of Bialystok, Bialystok, Poland (AH); the Home Enteral Nutrition Unit, Stomed, Ostroleka, Poland (GD); Gastroenterology and Oncology and Plastic Surgery, Medical University of Poznan, Poznan, Poland (KM); and Jagiellonian University Medical College, Chair of Epidemiology and Preventive Medicine, Department of Epidemiology, Krakow, Poland (AG).
authors: Grzegorz
authors: G
authors: Dziwiszek
authors: From Stanley Dudrick's Memorial Hospital, General and Oncology Surgery Unit, Skawina, Poland (SK, KS, and PS); the Department of Pediatric Surgery, Medical University of Bialystok, Bialystok, Poland (AH); the Home Enteral Nutrition Unit, Stomed, Ostroleka, Poland (GD); Gastroenterology and Oncology and Plastic Surgery, Medical University of Poznan, Poznan, Poland (KM); and Jagiellonian University Medical College, Chair of Epidemiology and Preventive Medicine, Department of Epidemiology, Krakow, Poland (AG).
authors: Konrad
authors: K
authors: Matysiak
authors: From Stanley Dudrick's Memorial Hospital, General and Oncology Surgery Unit, Skawina, Poland (SK, KS, and PS); the Department of Pediatric Surgery, Medical University of Bialystok, Bialystok, Poland (AH); the Home Enteral Nutrition Unit, Stomed, Ostroleka, Poland (GD); Gastroenterology and Oncology and Plastic Surgery, Medical University of Poznan, Poznan, Poland (KM); and Jagiellonian University Medical College, Chair of Epidemiology and Preventive Medicine, Department of Epidemiology, Krakow, Poland (AG).
authors: Kinga
authors: K
authors: Szczepanek
authors: From Stanley Dudrick's Memorial Hospital, General and Oncology Surgery Unit, Skawina, Poland (SK, KS, and PS); the Department of Pediatric Surgery, Medical University of Bialystok, Bialystok, Poland (AH); the Home Enteral Nutrition Unit, Stomed, Ostroleka, Poland (GD); Gastroenterology and Oncology and Plastic Surgery, Medical University of Poznan, Poznan, Poland (KM); and Jagiellonian University Medical College, Chair of Epidemiology and Preventive Medicine, Department of Epidemiology, Krakow, Poland (AG).
authors: Piotr
authors: P
authors: Szybinski
authors: From Stanley Dudrick's Memorial Hospital, General and Oncology Surgery Unit, Skawina, Poland (SK, KS, and PS); the Department of Pediatric Surgery, Medical University of Bialystok, Bialystok, Poland (AH); the Home Enteral Nutrition Unit, Stomed, Ostroleka, Poland (GD); Gastroenterology and Oncology and Plastic Surgery, Medical University of Poznan, Poznan, Poland (KM); and Jagiellonian University Medical College, Chair of Epidemiology and Preventive Medicine, Department of Epidemiology, Krakow, Poland (AG).
authors: Aleksander
authors: A
authors: Galas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D003365:Costs and Cost Analysis; D004750:Enteral Nutrition / Q000009:adverse effects / Q000191:economics*; D005260:Female; D005526:Food, Formulated / Q000009:adverse effects / Q000191:economics; D017048:Health Care Costs; D006699:Home Care Services / Q000191:economics*; D006792:House Calls / Q000191:economics; D006801:Humans; D017053:Infection Control / Q000191:economics*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011044:Poland; D015430:Weight Gain