Abstract

We describe a retrospective cohort study of patients with malignant bowel obstruction to examine their nutritional care pathways between 1.1.16 and 31.12.16 with readmissions until 31.12.17. Data were analyzed by comparing patients who were referred (R) and not referred (NR) for PN. We identified 72 patients with 117 MBO admissions (mean ± SD age:63.1 ± 13.1yrs, 79% female). 24/72 patients were in R group. Predominant primary malignancies were gynaecological and lower-gastrointestinal cancers (76%). 83% patients had metastases (61% sub-diaphragmatically). All patients were at high-risk of malnutrition and baseline mean weight loss was 7%. Discussion of PN at multidisciplinary team meeting (MDT) (22% vs.5%, P = 0.02) and dietetic contact (94% vs. 41%, P < 0.0001) were more likely to occur in the R group. In 13/69 MBO admissions in NR group, reasons for non-referral were unclear. Median baseline and follow-up weight was similar (55–55.8 kg). Overall survival was 4.7 (1.4–15.2)months, with no differences by referral groups. We compared a sub-sample of patients who ‘may have’ required PN (n = 10) vs. those discharged on home PN (n = 10) and found greater survival in the HPN group (323vs.91 day, P < 0.01). Our findings highlight disparity in care pathways suggesting that nutritional care should be integrated into clinical management discussion(s) at MDT to ensure equal access to nutritional services.

摘要

我们描述了一项对恶性肠梗阻患者的回顾性队列研究，以检查他们在 1.1.16 和 31.12.16 之间的营养保健途径，并在 17 年 12 月 17 日之前再次入院。通过比较转诊 (R) 和未转诊 (NR) PN 的患者来分析数据。我们确定了 72 名患者，其中 117 名 MBO 入院（平均 ± SD 年龄：63.1 ± 13.1 岁，79% 为女性）。24/72 例患者为 R 组。主要的原发性恶性肿瘤是妇科和下消化道癌症（76%）。83% 的患者有转移（61% 为膈下转移）。所有患者都处于营养不良的高风险中，基线平均体重减轻为 7%。在多学科团队会议 (MDT) 上讨论 PN（22% 对 5%，P  = 0.02）和饮食接触（94% 对 41%，P < 0.0001) 更可能发生在 R 组。在 NR 组 13/69 的 MBO 入院中，未转诊的原因尚不清楚。中位基线和随访体重相似（55-55.8 kg）。总生存期为 4.7 (1.4-15.2) 个月，转诊组之间没有差异。我们比较了患者谁“可以具有”要求PN（子样品Ñ  = 10）对那些家庭PN（放电Ñ  = 10）和HPN组中找到更大的生存（323vs.91天，P  <0.01） . 我们的研究结果突出了护理途径的差异，表明营养护理应纳入 MDT 的临床管理讨论中，以确保平等获得营养服务。