title: Impact of drug shortages on patients receiving parenteral nutrition after laparotomy.
abstract: BACKGROUND
  Drug shortages, including parenteral nutrition (PN) product shortages, continue to increase and have a significant impact on healthcare. The extent to which product shortages affect bowel recovery and outcomes in patients receiving PN is unknown. The objective of this study is to examine the impact of extensive PN product shortages on patients receiving PN after laparotomy for bowel obstruction.
  
  
  METHODS
  A retrospective review was conducted for patients who underwent a laparotomy for small bowel obstruction and received PN postoperatively. Periods of limited and extensive PN product shortages at our institution were defined. PN therapy duration and composition, daily laboratory values, electrolyte supplementation, length of stay, and cost of hospitalization were recorded. Analyses using χ(2), Wilcoxon rank sum, log-rank, and t tests as appropriate were performed using SAS/STAT 9.2.
  
  
  RESULTS
  Patients had longer hospital length of stays (20.0 vs 15.2 days; P = .04), trends toward longer PN therapy courses (8.8 vs 6.6 days; P = .13), and a 51% higher hospital cost during the extensive PN drug shortage period. Mean serum electrolyte concentrations were similar while the need for supplemental magnesium replacements increased during the extensive shortage period (75% vs 35%; P = .01). Supplemented patients also required higher doses of magnesium (2.7 vs 1.0 g; P < .01) and more laboratory draws during the extensive shortage period (59% vs 21% required ≥ 2 draws daily; P = .04). Fewer lipid calories were delivered during the extensive shortage period (2.4 vs 4.8 kcal/kg/d; P < .01).
  
  
  CONCLUSIONS
  PN drug shortages have a negative impact on patient outcomes and require aggressive management strategies.
authors.affiliation: Department of Pharmacy.
authors.forename: Jaimee R
authors.initials: JR
authors.lastname: Bible
authors.affiliation: Department of Surgery.
authors.forename: David C
authors.initials: DC
authors.lastname: Evans
authors.affiliation: Department of Clinical Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: Brett
authors.initials: B
authors.lastname: Payne
authors.affiliation: Department of Pharmacy Lisa.Mostafavifar@osumc.edu.
authors.forename: Lisa
authors.initials: L
authors.lastname: Mostafavifar
mesh_terms: D000368:Aged; D013505:Digestive System Surgical Procedures; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007415:Intestinal Obstruction / Q000191:economics / Q000601:surgery*; D007813:Laparotomy; D007902:Length of Stay; D008055:Lipids / Q000008:administration & dosage; D008274:Magnesium / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D004364:Pharmaceutical Preparations / Q000600:supply & distribution*; D011182:Postoperative Care; D012189:Retrospective Studies
chemical_list: D008055:Lipids; D004364:Pharmaceutical Preparations; D008274:Magnesium
keywords: drug shortages; laparotomy; nutrition; parenteral nutrition