64 Does a transanastomotic tube have an impact on the cost of nutrition in Congenital Duodenal Obstruction?
Rachel Harwood1, Violeta Tafilaj2, J Fraser Horwood1, Ross Craigie1
1Royal Manchester Children's Hospital, Manchester, United Kingdom. 2Manchester University, Manchester, United Kingdom


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.