Transanastomotic tube (TAT) placement during congenital duodenal obstruction (CDO) surgery has previously been shown to be safe, reduce the need for post-operative parenteral nutrition (PN), and the rates of sepsis.
Purpose: To determine the impact of an intra-operatively inserted Transanastomotic Tube (TAT) on the post-operative cost of nutrition in patients with congenital duodenal obstruction (CDO).
Methods: Retrospective analysis of patients admitted with CDO and a birth-weight over 1.5Kg was performed over a 10-year period. Number of days receiving any parenteral nutrition (PN) was recorded at a cost of £125 per day, as per hospital pharmacy costings. Number of days receiving any enteral nutrition was recorded at a cost of £0.90 per 60ml, assuming that 150ml/kg/day was given to ensure this is not under-costed. Data is presented as median (inter-quartile range) and analysed with Mann-Whitney U test and Fisher’s exact test as appropriate.
Results: 59 patients’ notes were analysed and there was no significant difference between the TAT and non-TAT groups with regards to gestation, birth weight, sex, age at operation and abnormality. There was a significant reduction in the duration of TPN administered (6 days (0-11) vs 12 (8-19) days, p=0.003), the cost of TPN (£750 (0-1375) vs £1500 (1000-2375), p=0.003) and the total cost of nutrition (£765.26 (38.36-1404) vs £1387.52 (1008.23-2363.08), p=0.015) in patients who had a TAT placed. There was a median cost saving of £622.26 in patients who had a TAT placed. 14% of patients had dislodgement of their TAT with no other TAT complications.Conclusion: The use of a TAT is a safe and effective way to reduce the duration of TPN required in patients with CDO. This infers a significant cost saving per patient, a factor that is important in this period of austerity.