Bible Jaimee R, Evans David C, Payne Brett, Mostafavifar Lisa
Department of Pharmacy.
Department of Surgery.
JPEN J Parenter Enteral Nutr. 2014 Nov;38(2 Suppl):65S-71S. doi: 10.1177/0148607114550317. Epub 2014 Sep 19.
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.
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.
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).
PN drug shortages have a negative impact on patient outcomes and require aggressive management strategies.
药品短缺，包括肠外营养（PN）产品短缺，持续增加并对医疗保健产生重大影响。产品短缺对接受PN治疗的患者肠道恢复及预后的影响程度尚不清楚。本研究的目的是探讨广泛的PN产品短缺对肠梗阻剖腹手术后接受PN治疗患者的影响。
对因小肠梗阻接受剖腹手术并术后接受PN治疗的患者进行回顾性研究。确定了本机构PN产品有限短缺期和广泛短缺期。记录PN治疗持续时间和组成、每日实验室检查值、电解质补充情况、住院时间和住院费用。使用SAS/STAT 9.2根据情况进行χ²检验、Wilcoxon秩和检验、对数秩检验和t检验分析。
在广泛的PN药品短缺期间，患者住院时间更长（20.0天对15.2天；P = 0.04），PN治疗疗程有延长趋势（8.8天对6.6天；P = 0.13），住院费用高出51%。平均血清电解质浓度相似，但在广泛短缺期间补充镁的需求增加（75%对35%；P = 0.01）。在广泛短缺期间，接受补充的患者还需要更高剂量的镁（2.7克对1.0克；P < 0.01），并且需要更多的实验室检查（59%对21%每天需要≥2次检查；P = 0.04）。在广泛短缺期间提供的脂肪热量较少（2.4千卡/千克/天对4.8千卡/千克/天；P < 0.01）。
PN药品短缺对患者预后有负面影响，需要积极的管理策略。
