PWE-120 An experience of home total parenteral nutrition at the freeman hospital over a 21-year period

Introduction Home total parenteral nutrition (HPN) is used for patients with severe intestinal failure. Our service at the Freeman Hospital, Newcastle upon Tyne covers Northumberland, North Cumbria, Durham, Gateshead, North Yorkshire, Tyneside, Wearside and Teesside. Methods This study used the database kept by the HPN service and the Trust document portal to gather data retrospectively regarding 221 patients started on HPN from 1996 till 2016.25 individual data sets were collated about each patient. Line sepsis rates were obtained from the trust central venous catheter surveillance data (this includes data for patient episodes at other hospitals). Results The study showed that over the 21 years, there has been a rapid growth in number of patients on HPN. Number of patients on HPN by year. The gender split of the cohort was 101 males and 120 females, with a total mean age 52.7 years and median age 55 years. Teesside (22%, 49/221) followed by Northumberland (18%, 40/221 ) were the regions with the most patients initiated on HPN. The three most common indications for HPN were Post-operative complications (30.3%, 67/221), Crohn’s disease (21.3%, 47/221) and Mesenteric ischaemia (16.7%, 37/221). 14.9% (33/221) patients were on HPN as a result of malignancy. The 1 year and 5 year survival for the cohort was 94% and 79.4% respectively. There were 73 deaths noted in the study group, 8 patients had stopped HPN prior to death. 29 of these patients had been on HPN of a result of malignancy. Of the 65 patients who died while being on HPN, only four deaths were clearly as a complication of parenteral nutrition. 8 patients had neuroendocrine tumours; their average time on HPN was significantly greater at 25.6 months compared to 5.6 months for patients with other tumour types. The mean rate of catheter-related bloodstream infection was 0.27 per 1000 catheter days over the period covering years 2011 till 2017. The rate of liver (significant fibrosis/cirrhosis) or biliary complications while being on HPN was 12% (27/221) and the commonest complication was biliary obstruction/cholangitis (33.3%, 9/27). 6 patients of the cohort underwent successful small bowel transplantation and were able to stop HPN. Conclusions The HPN service at the Freeman has noted a rapid growth in patient numbers, with survival rates comparable to or better than that reported in the literature. Mortality was linked to disease process rather than HPN complications and line infection rate was low.