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Outcome of intestinal failure after bariatric surgery: experience from a national UK referral centre
P J Allan1, P Stevens1, A Abraham1
1Intestinal Failure Unit, Salford Royal Hospital NHS Foundation Trust, Salford, UK.
Insights
Bariatric surgery can lead to intestinal failure (IF) requiring long-term home parenteral nutrition (HPN). Patients with IF after bariatric surgery experienced higher rates of catheter-related bloodstream infections (CRBSIs).
Area of Science:
- Gastroenterology
- Bariatric Surgery
- Nutritional Support
Background:
- Bariatric surgery offers sustained weight loss for morbid obesity.
- Complications include nutritional decline, with limited data on intestinal failure (IF) occurrence and outcomes.
Background/Objectives:
Bariatric surgery for morbid obesity provides sustained weight loss. Complications of bariatric surgery include severe nutritional decline, but minimal data describing occurrence and outcome of intestinal failure (IF) exist.
Subjects/Methods:
All patients referred to one of the UK's National IF units (IFU) are prospectively entered onto a database; case notes were assessed for bariatric surgery details, IF onset, outcomes, resulting intestinal anatomy, mortality and catheter-related bloodstream infections (CRBSIs).
Results:
A total of six patients (mean referral age 54.0 years; 95% confidence interval (CI): 44.6-63.4; 5 female) were identified with IF after bariatric surgery from 457 patients (total cohort) managed on home parenteral nutrition (HPN) at the IFU between 2008 and 2014. In all, 6/6 had Roux-en-Y gastric bypass bariatric surgery. Median (range) time from index bariatric surgery to IF development was 28.7 months (1.7-106). IF aetiology was internal herniation (4/6), ischaemia (1/6) and anastomotic leak (1/6); all patients required HPN for a median of 26.4 months (15.3-34.7). CRBSI occurred on 7 occasions in 3 patients, equivalent to 1.5/1000 catheter days in these 6 compared with 0.32/1000 in the 451 IFU HPN patients during this time period. In all, 0/6 patients died, 6/6 had continuity restored in a median of 16.5 months (6.5-32.5) after IF diagnosis and 3/6 (50%) were weaned from PN by a median of 2.2 months (0.6-12.8).
Conclusions:
Bariatric surgery, an increasingly common operation, can be associated with IF necessitating long-term HPN. The cohort presented had a higher CRBSI compared with other HPN patients; more stringent approaches to catheter care may be required in this patient group, although more collective data are required.