Interdisciplinary management of infantile short bowel syndrome: resource consumption, growth, and nutrition

Olieman, Joanne F.; Poley, Marten J.; Gischler, Saskia J.; Penning, Corine; Escher, Johanna C.; van den Hoonaard, Thelma L.; van Goudoever, Johannes B.; Bax, Nikolaas M.A.; Tibboel, Dick; IJsselstijn, Hanneke

doi:10.1016/j.jpedsurg.2009.08.009

« Previous Next »Journal of Pediatric Surgery
Volume 45, Issue 3 , Pages 490-498, March 2010

Interdisciplinary management of infantile short bowel syndrome: resource consumption, growth, and nutrition☆

Joanne F. Olieman
- Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Erasmus MC, 3000 CB Rotterdam, The Netherlands
- Department of Dietetics, Erasmus MC, 3000 CB Rotterdam, The Netherlands
Marten J. Poley
- Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Erasmus MC, 3000 CB Rotterdam, The Netherlands
- Institute for Medical Technology Assessment, Erasmus MC, 3000 CB Rotterdam, The Netherlands
Saskia J. Gischler
- Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Erasmus MC, 3000 CB Rotterdam, The Netherlands
Corine Penning
- Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Erasmus MC, 3000 CB Rotterdam, The Netherlands
- Department of Intellectual Disability Medicine/General Practice, Erasmus MC, 3000 CB Rotterdam, The Netherlands
Johanna C. Escher
- Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Erasmus MC, 3000 CB Rotterdam, The Netherlands
Thelma L. van den Hoonaard
- Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Erasmus MC, 3000 CB Rotterdam, The Netherlands
Johannes B. van Goudoever
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Erasmus MC, 3000 CB Rotterdam, The Netherlands
Nikolaas M.A. Bax
- Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Erasmus MC, 3000 CB Rotterdam, The Netherlands
Dick Tibboel
- Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Erasmus MC, 3000 CB Rotterdam, The Netherlands
- Corresponding author. PO Box 2060, 3000 CB Rotterdam, The Netherlands. Tel.: +31 10 7036567; fax: +31 10 7036288.
Hanneke IJsselstijn
- Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Erasmus MC, 3000 CB Rotterdam, The Netherlands

Received 9 March 2009; received in revised form 30 July 2009; accepted 2 August 2009.

Abstract

Background/Purpose

To date, there are hardly any data on the treatment costs of infantile short bowel syndrome (SBS), despite growing interest in evidence-based and cost-effective medicine. Therefore, the aim of the study was to evaluate resource consumption and costs, next to studying nutritional and growth outcomes, in children with SBS who were treated by an interdisciplinary short bowel team.

Methods

Data were collected for 10 children with infantile SBS (≤1 year of age) born between 2002 and 2007. Data included demographic and medical data of the first admission and data on resource consumption, growth, and type of nutrition for the total follow-up period. Real economic costs were calculated in Euro (€) and US dollar ($).

Results

Seven of the 10 patients were discharged with home parenteral nutrition. Total follow-up varied between 9 months and 5.5 years (median, 1.5 years). Six patients could be weaned off parenteral nutrition and 5 patients off enteral tube feeding, resulting in full oral intake. Seven patients had normal growth. Median duration of initial hospital admission was 174 days, and average costs of initial admission amounted to €166,045 ($218,681). Average total costs were €269,700 ($355,195), reaching to a maximum of €455,400 ($599,762). These costs mainly comprised hospital admissions (82%), followed by nutrition (12%), surgical interventions (5%), and outpatient visits (1%).

Conclusions

This study is among the first to describe resource consumption and costs in infants with SBS, examining real economic costs and extending beyond the initial hospitalization. Treatment of SBS requires considerable resource consumption, especially when patients depend on parenteral nutrition. Because the costs mainly comprise those of hospital admissions, early home parenteral nutrition could contribute to costs reduction. Interdisciplinary teams have the potential to facilitate early home parenteral nutrition and thus may reduce health care costs.

Key words: Infantile short bowel syndrome, Interdisciplinary team, Costs, Nutrition, Growth