A clinical and economic evaluation of enteral nutrition

The American Society of Parenteral and Enteral Nutrition (ASPEN) guidelines advise use of enteral nutrition (EN) for critically ill hospital patients requiring nutritional support, but no studies have comprehensively estimated economic benefits from adherence to this recommendation. We systematically reviewed studies comparing EN to alternative nutritional support therapies among adult, critically ill patients. We reviewed 1200 abstracts, selected 243 for further review, and included 48 studies in our analysis. Most retained studies compared EN and parenteral nutrition (PN). Using meta-analysis, we estimated the absolute impact of EN on adverse event risk and its impact on treatment duration and length of stay. These estimates were converted to population economic impacts by assuming 10% of PN patients are suitable candidates for EN. Compared to PN, EN reduces the risk of major, potentially life-threatening infections (RR = 0.58, 95% confidence interval [CI] 0.44 to 0.77), the risk of major, potentially life-threatening non-infection events (RR = 0.73, CI 0.59 to 0.91), and suggests a reduction in mortality, although this result did not achieve statistical significance (RR = 0.70, CI 0.45 to 1.09). EN also reduces inpatient length of stay, time in the ICU, and length of nutritional treatment. Compared to PN, EN savings from reduced adverse event risks average nearly $1500 per patient; savings from reduced hospital length of stay amount to nearly $2500 per patient. Shifting 10% of parenterally treated adult patients in the U.S. to EN would save $35 million annually due to reduced adverse events and another $57 million due to shorter hospital stays. The evidence of both clinical and economic gains from EN is consistent with ASPEN guidelines recommending use of EN in critically ill hospital patients when possible.