TY - JOUR
T1 - Report of 111 consecutive patients enrolled in the international serial transverse enteroplasty (STEP) data registry
T2 - A retrospective observational study
AU - Jones, Brian A.
AU - Hull, Melissa A.
AU - Potanos, Kristina M.
AU - Zurakowski, David
AU - Fitzgibbons, Shimae C.
AU - Ching, Y. Avery
AU - Duggan, Christopher
AU - Jaksic, Tom
AU - Kim, Heung Bae
PY - 2013/3
Y1 - 2013/3
N2 - Background: The International Serial Transverse Enteroplasty (STEP) Data Registry is a voluntary online database created in 2004 to collect information on patients undergoing the STEP procedure. The aim of this study was to identify preoperative factors that are significantly associated with transplantation or death or attainment of enteral autonomy after STEP. Study Design: Data were collected from September 2004 to January 2010. Univariate and multivariate logistic regression analyses were applied to determine the predictors of transplantation or death or enteral autonomy post-STEP. Time to reach full enteral nutrition was estimated using a Kaplan-Meier curve. Results: Fourteen of the 111 patients in the Registry were excluded due to inadequate follow-up. Of the remaining 97 patients, 11 patients died and 5 progressed to intestinal transplantation. On multivariate analysis, higher direct bilirubin and shorter pre-STEP bowel length were independently predictive of progression to transplantation or death (p = 0.05 and p < 0.001, respectively). Of the 78 patients who were 7 days of age or older and required parenteral nutrition at the time of STEP, 37 (47%) achieved enteral autonomy after the first STEP. Longer pre-STEP bowel length was also independently associated with enteral autonomy (p = 0.002). Median time to reach enteral autonomy based on Kaplan-Meier analysis was 21 months (95% CI, 12-30). Conclusions: Overall mortality post-STEP was 11%. Pre-STEP risk factors for progressing to transplantation or death were higher direct bilirubin and shorter bowel length. Among patients who underwent STEP for short bowel syndrome, 47% attained full enteral nutrition post-STEP. Patients with longer pre-STEP bowel length were significantly more likely to achieve enteral autonomy.
AB - Background: The International Serial Transverse Enteroplasty (STEP) Data Registry is a voluntary online database created in 2004 to collect information on patients undergoing the STEP procedure. The aim of this study was to identify preoperative factors that are significantly associated with transplantation or death or attainment of enteral autonomy after STEP. Study Design: Data were collected from September 2004 to January 2010. Univariate and multivariate logistic regression analyses were applied to determine the predictors of transplantation or death or enteral autonomy post-STEP. Time to reach full enteral nutrition was estimated using a Kaplan-Meier curve. Results: Fourteen of the 111 patients in the Registry were excluded due to inadequate follow-up. Of the remaining 97 patients, 11 patients died and 5 progressed to intestinal transplantation. On multivariate analysis, higher direct bilirubin and shorter pre-STEP bowel length were independently predictive of progression to transplantation or death (p = 0.05 and p < 0.001, respectively). Of the 78 patients who were 7 days of age or older and required parenteral nutrition at the time of STEP, 37 (47%) achieved enteral autonomy after the first STEP. Longer pre-STEP bowel length was also independently associated with enteral autonomy (p = 0.002). Median time to reach enteral autonomy based on Kaplan-Meier analysis was 21 months (95% CI, 12-30). Conclusions: Overall mortality post-STEP was 11%. Pre-STEP risk factors for progressing to transplantation or death were higher direct bilirubin and shorter bowel length. Among patients who underwent STEP for short bowel syndrome, 47% attained full enteral nutrition post-STEP. Patients with longer pre-STEP bowel length were significantly more likely to achieve enteral autonomy.
KW - PN
KW - SBS
KW - STEP
KW - aMSA
KW - actual mucosal surface area
KW - fMSA
KW - functional mucosal surface area
KW - parenteral nutrition
KW - serial transverse enteroplasty
KW - short bowel syndrome
UR - http://www.scopus.com/inward/record.url?scp=84873991407&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84873991407&partnerID=8YFLogxK
U2 - 10.1016/j.jamcollsurg.2012.12.018
DO - 10.1016/j.jamcollsurg.2012.12.018
M3 - Article
C2 - 23357726
AN - SCOPUS:84873991407
SN - 1072-7515
VL - 216
SP - 438
EP - 446
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 3
ER -