4CPS-062 Clinical and economic impact of inappropriate use of total parenteral nutrition in adults

<h3>Background and Importance</h3> According to the latest clinical nutrition guidelines, total parenteral nutrition(TPN) is recommended for hospitalised patients at high-risk of malnutrition when nutrient intake via the digestive tract is expected to be impossible or insufficient for more than 5–7days. <h3>Aim and Objectives</h3> To evaluate the appropriateness of TPN use in a tertiary care hospital and the economic impact resulting from its improper indication. <h3>Material and Methods</h3> We conducted a retrospective review of medical records from adult patients who received TPN at a tertiary hospital in 2023. Using two software applications for electronic health record access,SAP and Pharmasuite, we extracted data on TPN duration, the number of TPN bags prepared, and the reasons for initiating and discontinuing TPN. For patients on TPN≤5 days, we also recorded type of TPN prescribed and calculated preparation costs. Data were collected in Excel database. To obtain the results, data were analysed by using SPSS-Statistics software.Qualitative variables were reported as percentages,and quantitatives as means±standard deviation. <h3>Results</h3> A total of 401 patients were included. Of these,16.9% received TPN for 5 days or fewer:36.8% for 5 days, 27.9% for 4 days, 17.6% for 3 days, 7.4% for 2 days, 4.4% for 1 day and 5.9% didn’t start TPN. A total of 5653 TPN bags were prepared,5.2% of which were for patients with TPN≤5 days. The main reasons for starting TPN were:23.5% digestive surgery, 23.5% paralytic ileus, 10.3% intolerance to enteral nutrition(EN), 10.3% persistent vomiting/diarrhoea, 7.4% peritonitis, 5.9% inadequate oral tolerance, 5.9% diverticulitis, 5.9% intestinal obstruction,4.4% pancreatitis and 2.9% mucositis. Reasons for discontinuation were:61.8% oral diet tolerance, 17.6% patient death, 7.4% EN tolerance, 4.4% patient decision,4.4% lack of central venous catheter,2.8% discharge and 1.5% TPN associated complications.The direct cost associated with TPN for ≤ 5 days was 12,102.14€, with an average cost of 177.97±61.18€ per patient. <h3>Conclusion and Relevance</h3> One-sixth of TPN prescriptions did not align with clinical guidelines, causing a significant economic impact. Early initiation of oral diet was a key factor in TPN≤5 days. Proper planning of fasting duration and transition to oral intake is crucial to reduce costs, complications, and logistical burdens. <h3>References and/or Acknowledgements</h3> Worthington P, <i>et al</i>. When is parenteral nutrition appropriate. <i>JPEN J Parenter Enteral Nutr</i>. 2017;<b>41</b>(3):324–77. Thibault R, <i>et al</i>. ESPEN guideline on hospital nutrition 2021;<b>40</b>(12):5684–709 <h3>Conflict of Interest</h3> No conflict of interest