Bridging-to-Surgery in Patients with Type 2 Intestinal Failure

Area of Science:

• Gastroenterology
• Surgical Management
• Clinical Nutrition

Background:

• Type 2 intestinal failure (IF) necessitates long-term parenteral nutrition (PN), a period with high morbidity and mortality.
• The "bridging-to-surgery" phase for IF patients requires specialized management to improve outcomes.

Purpose of the Study:

• To evaluate the efficacy of a multidisciplinary IF team in safely managing type 2 IF patients during the bridging-to-surgery period.
• To assess the improvement in patient recovery metrics before reconstructive surgery under IF team guidance.

Main Methods:

• Analysis of a consecutive series of 93 type 2 IF patients managed by a specialized IF team from January 2011 to March 2016.
• Comparison of patient outcomes at the first IF team consultation (T1) versus the last visit before surgery (T2).
• Primary outcome: combined endpoint of home recovery, partial oral intake, and normal albumin (> 35 g/L) before surgery.

Main Results:

• Significantly more patients met the primary endpoint at T2 (66.7%) compared to T1 (28.0%) (p < 0.0001).
• At T2, 86% of patients were on home PN, with 86% regaining enteral autonomy postoperatively (94.1% excluding in-hospital mortality/incomplete follow-up).
• Risk factors for major complications included low T2 albumin and significant weight loss.

Conclusions:

• Multidisciplinary IF team management significantly improves outcomes for type 2 IF patients during the bridging-to-surgery phase.
• The majority of patients can be safely managed at home with improved nutritional status prior to reconstructive surgery.