Skip to main content
SpringerLink
Log in

Transanastomotic tubes reduce the cost of nutritional support in neonates with congenital duodenal obstruction

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

To determine the impact of intra-operative Trans-anastomotic Tube (TAT) placement on the cost of post-operative nutrition in infants with congenital duodenal obstruction (CDO).

Methods

A retrospective analysis of patients undergoing corrective surgery for CDO, with birth-weight over 1.5 kg over a 10-year period. Data are presented as median (inter-quartile range) and analysed with Mann–Whitney U test and Fisher’s exact test as appropriate.

Results

59 patients were included. There was no difference between TAT and non-TAT groups for baseline characteristics, age at operation and abnormality. In the TAT group there was a significant reduction in the duration of post-operative parenteral nutrition (PN) [6 (0–11) vs 12 (8–19) days, p = 0.006], the cost of PN [£750 (0–1375) vs £1500 (1000–2375), p = 0.006] and the total cost of nutrition [£765.26 (38.36–1404) vs £1387.52 (1008.23–2363.08), p = 0.015], thereby demonstrating a median cost saving of £622.26 per patient. 14% experienced TAT displacement but no other TAT complications were encountered.

Conclusion

The use of a TAT is a safe and effective way to reduce the duration of PN required in patients with CDO. This infers a significant cost saving per patient, a factor that cannot be overlooked in this period of austerity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cho MJ, Kim DY, Kim SC, Namgoong JM (2017) Transition from laparotomy to laparoscopic repair of congenital duodenal obstruction in neonates: our early experience. Front Pediatr 5:203

    Article  PubMed  PubMed Central  Google Scholar 

  2. Takahashi A, Tomomasa T, Suzuki N, Kuroiwa M, Ikeda H, Morikawa A et al (1997) The relationship between disturbed transit and dilated bowel, and manometric findings of dilated bowel in patients with duodenal atresia and stenosis. J Paediatr Surg 38(8):1157

    Article  Google Scholar 

  3. Ekingen G, Ceran C, Guvenc BH, Tuzlaci A, Kahraman H (2005) Early enteral feeding in newborn surgical patients. Nutrition 21(2):142–146

    Article  PubMed  Google Scholar 

  4. Hall N, Drewett M, Wheeler R (2011) Transanastomotic tubes reduce the need for central venous access and parenteral nutrition in infants with congenital duodenal obstruction. Pediatr Surg Int 27:851–855

    Article  PubMed  CAS  Google Scholar 

  5. Bishay M, Lakshminarayanan B, Arnord A (2013) The role of parenteral nutrition following surgery for duodenal obstruction or stenosis. Pediatr Surg Int 29:191–195

    Article  PubMed  CAS  Google Scholar 

  6. Murray R, Imison C, Jabbal J (2014) Financial failure in the NHS—what causes it and how best to manage it. The King’s Fund, London

    Google Scholar 

  7. Osifo OD, Okolo CJ (2009) Management of intestinal atresia: challenges and outcomes in a resource-scarce region. Surg Pract 13(2):36–41

    Article  Google Scholar 

  8. Marshall Niles SG, Mitchell-Fearon K, Gill MI, DeSouza CJ, Fearon IC, Abel CA et al (2017) Mortality-related factors in gastroschisis—a Jamaican perspective. J Pediatr Surg 52(4):530–533

    Article  PubMed  Google Scholar 

  9. Davis K, Stremikis K, Squires D, Schoen C (2014) Mirror, mirror on the wall, 2014 update: how the U.S. Health Care System Compares Internationally. The Commonwealth Fund Report

  10. Schneider EC, Sarnak DO, Squires D, Shah A, Doty MM (2017) Mirror, mirror 2017: international comparison reflects flaws and opportunities for better U.S. Health Care. The Commonwealth Fund Report

  11. Five Year Forward View (2014) NHS England

  12. Lord Carter of Coles (2015) Review of operational productivity in NHS providers: Interim report. Department of Health, UK

    Google Scholar 

  13. Vogenberg F, Santilli J (2018) Healthcare trends for 2018. Am Health Drug Benef 11(1):48–54

    Google Scholar 

  14. Rattan K, Singh J, Dalel P (2016) Neonatal duodenal obstruction: a 15-year experience. J Neonatal Surg 5(2):13

    PubMed  PubMed Central  Google Scholar 

  15. Braeggar C, Decsi T, Dias J, Hartman C, Kolack S, Koletzko B et al (2010) Practical approach to paediatric enteral nutrition: a comment by the ESPGHAN committee on nutrition. J Pediatr Gastroenterol Nutr 51(1):110–122

    Article  Google Scholar 

  16. Jiang W, Lv x, Xu X, Geng Q, Zhang J, Tang W (2015) Early enteral nutrition for upper digestive tract malformation in neonate. Asia Pac J Clin Nutr 24(1):38–43

    PubMed  CAS  Google Scholar 

  17. Ruangtrakool R, Mungnirandar A, Laohapensang M, Sathornkich C (2001) Surgical treatment for congenital duodenal obstruction. J Med Assoc Thail 84(6):842–849

    CAS  Google Scholar 

  18. Sun S, Samuels S, Lee J, Marquis J (1975) Duodenal perforation: a rare complication of neonatal nasojejunal tube feeding. Pediatrics 55(3):371–375

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

R. Harwood has received a research grant from Alder Hey Children’s Kidney fund from August 2017–August 2018 and from Kidney Research UK from August 2018–August 2020 (Grant number TF_010_20171124).

Author information

Authors and Affiliations

  1. Department of Paediatric Surgery, Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK

    Rachel Harwood, Fraser Horwood & Ross J. Craigie

  2. University of Liverpool, Liverpool, UK

    Rachel Harwood

  3. University of Manchester, Manchester, UK

    Violeta Tafilaj

Authors
  1. Rachel Harwood
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fraser Horwood
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Violeta Tafilaj
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ross J. Craigie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rachel Harwood.

Ethics declarations

Conflict of interest

There are no conflicts of interest in any of the authors who contributed to this study, either financially or otherwise. R. H declares no conflicts of interest, J. F. Horwood declares that he has no conflict of interest, V. Tafilaj declares that she has no conflict of interest, R. Craigie declares that he has no conflict of interest.

Human and animal rights statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. As this is a retrospective study and there is no inclusion of individually identifiable patients, formal consent was not required and was therefore not requested.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Harwood, R., Horwood, F., Tafilaj, V. et al. Transanastomotic tubes reduce the cost of nutritional support in neonates with congenital duodenal obstruction. Pediatr Surg Int 35, 457–461 (2019). https://doi.org/10.1007/s00383-018-4411-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-018-4411-5

Keywords

Search

Navigation