Klek Stanislaw, Hermanowicz Adam, Dziwiszek Grzegorz, Matysiak Konrad, Szczepanek Kinga, Szybinski Piotr, Galas Aleksander
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).
Am J Clin Nutr. 2014 Aug;100(2):609-15. doi: 10.3945/ajcn.113.082842. Epub 2014 Jun 25.
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.
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.
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.
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.
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.
家庭肠内营养（HEN）一直被视为一种挽救生命的手段，但随着持续的经济危机影响医疗保健，其成本效益最近受到了质疑。
波兰独特的报销情况使得在伦理上不可接受因而无法进行的无喂养期与长期喂养期的比较以及对长期喂养的临床价值及其成本效益的后续分析成为可能。
2007年1月至2013年7月期间，对456例接受家庭肠内营养的患者进行了一项观察性多中心研究[142名儿童：55名女孩和87名男孩，平均（±标准差）年龄8.7±5.9岁；314名成年人：151名女性和163名男性，平均年龄59.3±19.8岁]。比较了两个12个月的时间段。在第一个时间段，患者通过鼻饲给予自制饮食且未进行监测；在另一个时间段，患者接受家庭肠内营养。家庭肠内营养包括鼻饲和由营养支持团队进行的综合监测。比较了并发症的数量、住院次数、住院时间、生化和人体测量学变量以及住院费用。
实施家庭肠内营养使两个年龄组的体重增加且肝功能稳定，但对其他检查几乎没有影响。实施家庭肠内营养降低了感染性并发症的发生率（分别为37.4%和14.9%；P<0.001，McNemar检验）、住院次数[肠内营养前为1.98±2.42（平均±标准差），肠内营养后为1.26±2.18；P<0.001，Wilcoxon符号秩检验]以及住院时间（分别为39.7±71.9天和11.9±28.5天；P<0.001，Wilcoxon符号秩检验）。住院的年均费用（美元）从6500.20±10402.69降至2072.58±5497.00。
该研究表明家庭肠内营养改善了临床结局并降低了医疗保健成本。然而，无法确切确定哪个因素更重要：人工饮食本身还是综合护理的引入。
