title: Home parenteral nutrition (HPN) in patients with post-bariatric surgery complications.
abstract: Obesity is a worldwide health problem. Bariatric surgery (BS) is becoming one of the most commonly used methods for fighting obesity and its associated comorbidities. However, current BS techniques can be associated with early or late complications that may require nutritional support. The aim of this retrospective observational study was to determine the indications and outcomes for patients on Home parenteral nutrition (HPN) due to post-bariatric surgery complications.
  
  
  
  A specific questionnaire was designed by the ESPEN HAN/CIF working group and submitted to HPN centers. This questionnaire included: patient demographics, type of surgery, BMI before surgery and at start of HPN, indications for HPN including technical and nutritional complications (early within 2 months after surgery or late), outcome, PN regimen, and HPN complications. Patients were retrospectively included from January 2008 to June 2014.
  
  
  
  Eighteen HPN centers responded to the survey. A total of 2880 HPN patients were treated during the study period, 77 of whom had BS (65 females; mean age 51 ± 7 years); gastric bypass was performed in 69% of the patients; mean BMI was 44.4 before surgery and 23.2 at the start of HPN. Indications for HPN were early complications in 17 cases and late complications in 60 cases. Early complications were mostly anastomotic leakage/fistula; late complications were hypoalbuminemia, and vitamin and trace element deficiencies. Out of 77 patients, 16 needed a surgical re-intervention, 29 were weaned off HPN, and 6 died (no HPN-related deaths). During the HPN period, 58% of the patients were re-hospitalized and central venous complications were observed in 41%. Diabetes mellitus was described in 17/77 patients. HPN was supportive in 60 patients and exclusive in 17 patients (mean caloric intake: 23 ± 6 kcal/k BW/day and 1.2 g/kBW/day). Only 7/77 patients resumed their professional activities on HPN.
  
  
  
  This is the largest observational multicenter study describing the use of HPN in patients with post-BS complications. Severe hypoalbuminemia is a major late complication. Rates of re-hospitalization and CVC infection were high. HPN may be a "bridge therapy" before surgical revision after BS. The high mortality rate reflects the complexity of these cases.
authors.affiliation: Clinic of Intestinal Diseases and Clinical Nutrition, Hôpital Erasme, Free University of Brussels, Brussels, Belgium. Electronic address: Andre.VanGossum@erasme.ulb.ac.be.
authors.forename: A
authors.initials: A
authors.lastname: Van Gossum
authors.affiliation: Center for Chronic Intestinal Failure, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Pironi
authors.affiliation: Hôpital de la Croix Rousse, Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Chambrier
authors.affiliation: HPN Center, Gasthuisberg Hospital, Leuven, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Dreesen
authors.affiliation: Medical Gastroenterology Department, Righospital, Copenhagen, Denmark.
authors.forename: C F
authors.initials: CF
authors.lastname: Brandt
authors.affiliation: Internal Medicine and Clinical Nutrition, Federics II University, Naples, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Santarpia
authors.affiliation: Department of Gastroenterology and Nutrition Support, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris VII, Clichy, France.
authors.forename: F
authors.initials: F
authors.lastname: Joly
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000209:etiology / Q000628:therapy; D050110:Bariatric Surgery / Q000009:adverse effects*; D015992:Body Mass Index; D004041:Dietary Fats / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D005260:Female; D015390:Gastric Bypass; D006760:Hospitalization; D006801:Humans; D034141:Hypoalbuminemia / Q000209:etiology / Q000628:therapy; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000628:therapy; D018977:Micronutrients / Q000097:blood / Q000172:deficiency; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery; D016331:Parenteral Nutrition, Home; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
chemical_list: D004041:Dietary Fats; D004044:Dietary Proteins; D018977:Micronutrients
keywords: Bariatric surgery; Home parenteral nutrition; Obesity; Parenteral nutrition