Survival and parenteral nutrition dependence in patients aged 65 and older with short bowel syndrome: a retrospective observational cohort study.

Background: Home parenteral support (PS) is the standard treatment for chronic intestinal failure (CIF) with short bowel syndrome (SBS) as the leading cause. However, outcomes of PS in older patients remain poorly studied.

Methods: This retrospective observational study evaluated patients newly diagnosed with SBS-CIF initiating PS between 2015 and 2020 at a national French CIF referral center. Patients were stratified into two groups: ≥65 years (older group) and <65 years (younger group). Multivariate Cox regression identified predictors of mortality and PS dependence in older patients.

Results: We included 175 patients [median age 61 (interquartile range IQR: 46-70); 58% female]. Mesenteric ischemia was the primary cause of CIF (32%). Surgical anatomy included jejunostomy (47%), jejunocolic (39%) and ileocolic anastomosis (14%). Older patients [n=73, 42%, median age 72(68-76)] had higher rates of arterial hypertension, dyslipidemia, cancer, and SBS-CIF caused by radiation enteritis, but fewer cases attributed to Crohn's disease. After a median follow-up of 27 months (95%CI = 22-32), the probability of survival was 92% (95%CI = 88-97), and the probability of PS dependence was 68% (95%CI = 60-78), with no significant difference between age groups. In older patients, the presence of a jejunostomy (HR: 3.4, 95% CI: 1.1-10.6) was an independent predictor of PS dependence, and body mass index (BMI) < 22 HR 10.9, 95% CI: 1.4-87.4) was an independent predictor of mortality. Fourteen patients (8%) were treated with teduglutide, with no significant difference between age groups.

Conclusion: Nearly half of SBS-CIF patients on PS were aged ≥65, with PS dependence and survival rates comparable to younger patients. These findings suggest that age should not be a barrier to PS initiation.