Impact of Drug Shortages on Patients Receiving Parenteral Nutrition After Laparotomy
Impact of Drug Shortages on Patients Receiving Parenteral Nutrition After Laparotomy
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DOI：
10.1177/0148607114550317
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发表时间：
2014-11-01
影响因子：
3.4
通讯作者：
Mostafavifar, Lisa
中科院分区：
文献类型：
--
作者：
Bible, Jaimee R.;Evans, David C.;Mostafavifar, Lisa
背景：药物短缺，包括肠外营养（PN）产品短缺，继续增加，并对医疗保健产生重大影响。产品短缺对接受PN患者的肠道恢复和结局的影响程度尚不清楚。本研究的目的是检查广泛的PN产品短缺对肠梗阻剖腹术后接受PN的患者的影响。方法：回顾性分析因小肠梗阻行开腹手术并在术后接受PN的患者。定义了我们机构有限和广泛PN产品短缺的时期。记录PN治疗持续时间和组成、每日实验室检查值、电解质补充、住院时间和住院费用。使用SAS/STAT 9.2进行分析（2）、Wilcoxon秩和、对数秩和t检验（如适用）。结果如下：患者住院时间较长（20.0 vs 15.2天; P = 0.04），PN疗程有延长趋势（8.8 vs 6.6天; P = 0.13），在广泛的PN药物短缺期间，住院费用高出51%。平均血清电解质浓度相似，而在广泛短缺期间，补充镁替代品的需求增加（75% vs 35%; P = 0.01）。补充镁的患者也需要更高剂量的镁（2.7 vs 1.0 g; P <0.01）和更多的实验室抽血（59% vs 21%需要每天抽血2次; P = 0.04）。在广泛的短缺期间，提供的脂肪热量较少（2.4与4.8千卡/千克/天; P <0.01）。结论：PN药物短缺对患者结局有负面影响，需要积极的管理策略。
Background: Drug shortages, including parenteral nutrition (PN) product shortages, continue to increase and have a significant impact on healthcare. The extent to which product shortages affect bowel recovery and outcomes in patients receiving PN is unknown. The objective of this study is to examine the impact of extensive PN product shortages on patients receiving PN after laparotomy for bowel obstruction. Methods: A retrospective review was conducted for patients who underwent a laparotomy for small bowel obstruction and received PN postoperatively. Periods of limited and extensive PN product shortages at our institution were defined. PN therapy duration and composition, daily laboratory values, electrolyte supplementation, length of stay, and cost of hospitalization were recorded. Analyses using (2), Wilcoxon rank sum, log-rank, and t tests as appropriate were performed using SAS/STAT 9.2. Results: Patients had longer hospital length of stays (20.0 vs 15.2 days; P = .04), trends toward longer PN therapy courses (8.8 vs 6.6 days; P = .13), and a 51% higher hospital cost during the extensive PN drug shortage period. Mean serum electrolyte concentrations were similar while the need for supplemental magnesium replacements increased during the extensive shortage period (75% vs 35%; P = .01). Supplemented patients also required higher doses of magnesium (2.7 vs 1.0 g; P < .01) and more laboratory draws during the extensive shortage period (59% vs 21% required 2 draws daily; P = .04). Fewer lipid calories were delivered during the extensive shortage period (2.4 vs 4.8 kcal/kg/d; P < .01). Conclusion: PN drug shortages have a negative impact on patient outcomes and require aggressive management strategies.