Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford M6 8HD, UK.
School of Health Sciences, University of Manchester, Manchester M13 9PL, UK.
Nutrients. 2022 Aug 17;14(16):3379. doi: 10.3390/nu14163379.
Lack of expertise in home parenteral nutrition (HPN) management has been reported as a barrier to its initiation in patients with advanced cancer (AC), and there are limited data describing hospital readmissions and HPN-related complications. We aimed to assess a centralized approach for managing HPN in AC and evaluate associated outcomes, including hospital readmissions and HPN-related complications. This was a cohort study of adults with AC requiring palliative HPN between 2010-2018 at a tertiary intestinal failure (IF) center, primarily utilizing a centralized model of HPN oversight to discharge patients remotely from an oncology center to their homes over a wide geographic area. A total of 126 patients were included, with a median distance between the patient's home and the IF center of 17.5 km (IQR 10.9-39.1; maximum 317.4 km). A total of 28 (22%) patients experienced at least one HPN-related complication, the most common being a central venous catheter (CVC) occlusion and electrolyte abnormalities. The catheter-related bloodstream infection (CRBSI) rate was 0.49/1000 catheter days. The CVC type, administration of concomitant chemotherapy via a distinct CVC lumen separate from PN, venting gastrostomy and distance between the patient's home and the IF center were not associated with CRBSI or mechanical CVC complications. A total of 82 (65.1%) patients were readmitted while on HPN, but only 7 (8.5%) of these readmissions were HPN-related. A total of 44 (34.9%) patients died at home, 41 (32.5%) at a hospice and 41 (32.5%) in a hospital. In conclusion, this study demonstrates that a centralized approach to IF care can provide HPN to patients over a large geographical area while maintaining low HPN-related complications that are comparable to patients requiring HPN for benign conditions and low hospital readmission rates.
缺乏家庭肠外营养（HPN）管理方面的专业知识被报道为在晚期癌症（AC）患者中启动 HPN 的障碍，并且关于医院再入院和 HPN 相关并发症的数据有限。我们旨在评估一种集中管理 AC 中 HPN 的方法，并评估相关结局，包括医院再入院和 HPN 相关并发症。这是一项在 2010 年至 2018 年间在一家三级肠衰竭（IF）中心接受姑息性 HPN 的 AC 成人患者的队列研究，主要利用 HPN 监督的集中模型，使患者从肿瘤中心远程出院到家中，覆盖广泛的地理区域。共纳入 126 例患者，患者家庭与 IF 中心之间的中位数距离为 17.5 公里（IQR 10.9-39.1；最大 317.4 公里）。共有 28 例（22%）患者至少经历过一次 HPN 相关并发症，最常见的是中心静脉导管（CVC）阻塞和电解质异常。导管相关血流感染（CRBSI）率为 0.49/1000 导管日。CVC 类型、通过与 PN 分开的单独 CVC 管腔给予同时化疗、胃造口排气以及患者家庭与 IF 中心之间的距离与 CRBSI 或机械性 CVC 并发症无关。共有 82 例（65.1%）患者在接受 HPN 时再次入院，但其中只有 7 例（8.5%）与 HPN 相关。共有 44 例（34.9%）患者在家中死亡，41 例（32.5%）在临终关怀机构死亡，41 例（32.5%）在医院死亡。总之，这项研究表明，集中管理 IF 护理的方法可以为广大地理区域的患者提供 HPN，同时保持低 HPN 相关并发症，与需要 HPN 治疗良性疾病的患者和低医院再入院率相当。
