Home parenteral nutrition in patients with postbariatric surgery complications

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• 作者：A. Van Gossum¹ ; ^{Andre.Van.Gossum@ulb.ac.be" class="auth_mail" title="E-mail the corresponding author} ; L. Pironi² ; M. Dressen³ ; F. Joly⁴
• 刊名：Nutrition Clinique et Métabolisme
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：30
• 期：1
• 页码：64
• 全文大小：194 K

文摘

Obesity is a worldwide health problem. Bariatric surgery is becoming one of the most commonly used methods for fighting obesity and its associated comorbidities. Any type of bariatric surgery techniques may induce early or late complications that may require a nutritional support. The aim of this retrospective observational study is to determine the indications for home parenteral nutrition in patients who developed post-bariatric surgery complications and the outcome.

Material and methods

A specific questionnaire was designed by the ESPEN HAN/CIF working group and submitted to centres administering home parenteral nutrition. This questionnaire included: patients’ demographics, type of surgery, BMI before surgery and at start of home parenteral nutrition, indications for home parenteral nutrition (early within 2 months after surgery or late), including technical and nutritional complications, outcome, parenteral nutrition regimen, complications. Patients were retrospectively included from January 2008 to June 2014.

Results

Eighteen centres answered, covering a total of 2880 patients during this period, 77 of whom had had bariatric surgery (65 females; mean age 51 ± 7 years); gastric by-pass was performed in 69% of the patients; the mean BMI was 44.4 and 23.2 before surgery and at start of home parenteral nutrition, respectively. Indications for home parenteral nutrition were early complications in 17 cases and late complications in 60 cases. Early complications were mostly anastomotic leakage/fistula; late complications were hypoalbuminemia, vitamins, trace elements deficiencies. Out of 77 patients, 16 needed a surgical reintervention, 29 were weaned off home parenteral nutrition but six died (causes unrelated to home parenteral nutrition). During the study period, 58% of the patients were rehospitalized and central venous complications were observed in 41%. Diabetes mellitus was described in 17 patients out of 77. Home parenteral nutrition 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 seven patients out of 77 had professional activities while on home parenteral nutrition.

Conclusions

This is the largest observational multicenter study that describes the use of home parenteral nutrition in patients with post-bariatric surgery complications. Severe hypoalbuminemia is a major late complication. Rate of rehospitalisation and CVC infection are high. Home parenteral nutrition may be a “bridge therapy” before surgical revision. The high mortality rate reflects the complexity of these cases.