A Retrospective Look at TPN with Pancreatitis: Do Recommendations Match Guidelines? (P12-036-19)

Abstract

Objectives The objective of this project was to assess if best practice guidelines for the use of total parenteral nutrition (TPN) in pancreatitis are being followed at a university teaching hospital. Methods This retrospective study was an exploratory analysis of de-identified data pulled from a university teaching hospital clinical data repository and electronic medical records for patients who had a diagnosis of pancreatitis between the years of 2014 and 2018. Variables of interest included diagnosis, reason for initiating TPN, diet order, past medical history, age, gender, and race. Feeding modalities were compared to best practice guidelines for nutrition support initiation in pancreatitis provided by the American Society for Parenteral and Enteral Nutrition (ASPEN), European Society for Parenteral and Enteral Nutrition (ESPEN), American Pancreatic Association and the International Association of Pancreatology (IAP/APA), Best Practice in Surgery group at the University of Toronto, and the American College of Gastroenterology (ACG). Results A total of 57 patients were admitted between 2014 and 2018 with the diagnosis of pancreatitis. Chart reviews of each patient were assessed for an initial nutrition regimen of either enteral nutrition (EN) or TPN. Of the 57 patients started on nutrition support, 12 patients (21%) received a trial of EN prior to starting TPN. After exclusion of eight patients who had a diagnosis of either ileus, small bowel obstruction (SBO) or bowel perforation, there were 37 (65%) patients who were started on TPN initially without an EN trial. Conclusions Despite best practice guidelines from multiple groups advocating for EN over TPN, it was found that TPN appears to be a first line feeding strategy in the majority of patients admitted with or who developed pancreatitis at this hospital. Development of an interdisciplinary nutrition support team at this hospital is recommended to facilitate adherence to best practices regarding treatment of patients with pancreatitis. Funding Sources Not Applicable.