LONG-TERM OUTCOME AND COST-EFFECTIVENESS OF PARENTERAL-NUTRITION FOR ACUTE GASTROINTESTINAL FAILURE

Although there are several published audits of long-term home parenter al nutrition for chronic gastrointestinal failure, there is little dat a concerning the long-term outcome following prolonged in-patient pare nteral nutrition for an episode of acute gastrointestinal failure. Bet ween 1983 and 1 July 1993, 162 patients received total parenteral nutr ition (TPN) in our unit for acute gastrointestinal failure for a total of 4997 patient days and using 192 central venous catheters. Over the 10 years there were 11 mechanical complications resulting in one deat h. Although the overall catheter infection rate was 5.7%, in the last 4 years it was 0%, associated with a reduction in the frequency of sit e dressing and change of giving set from three times to once weekly. A ll patients had lost more than 10% of their body weight before TPN. In the non-malignant group, fed for more than 21 days (mean 50 days), th e 10-year survival was 74% at a cost of pound 4723 per year of life sa ved. In the malignant group, the 5-year survival was 27% at a cost of pound 8351 per year of life saved. These costs compare favourably with other technologies, such as dialysis for acute renal failure. Better patient selection, fewer complications and lower costs are obtained wh en this treatment is carried out by an expert team.