Systematic review with meta‐analysis: effects of implementing a nutrition support team for in‐hospital parenteral nutrition

BACKGROUND: Nutrition support teams (NST) may improve parenteral nutrition (PN) outcomes. No previous systematic review has provided conclusive data on catheter‐related infection (CRI) occurrence after NST introduction, nor have previous studies performed meta‐analysis or graded the evidence. AIMS: To systematically evaluate the effects of implementing an NST for hospitalised adults on PN and compare these with standard care. METHODS: This was a systematic review and meta‐analysis, pre‐registered in PROSPERO (CRD42020218094). On November 24, 2020, PubMed, Web of science, Scopus, Embase, Cochrane Library, and Clinical Key were searched. Clinical trials and observational studies with a standard care comparator were included. Primary outcome was relative reduction in CRI rate. A random‐effects meta‐analysis was used to estimate effects, and evidence was rated using Cochrane and GRADE methodologies. RESULTS: Twenty‐seven studies with 8166 patients were included. Across 10 studies, NST introduction reduced the CRI rate (IRR = 0.32, 95% CI: 0.19‐0.53) with −8 (95% CI: −12 to −5) episodes per 1000 catheter days compared with standard care. Hypophosphataemia occurred less frequently (IRD = −12%, 95% CI: −24% to −1%) and 30‐day mortality decreased (IRD = −6%, 95% CI: −11% to −1%). Inappropriate PN use decreased, both judged by indication (IRD = −18%, 95% CI: −28% to −9%) and duration (IRD = −21%, 95% CI: −33% to −9%). Evidence was rated very low to moderate. CONCLUSIONS: This study documents the clinical impact of introducing an NST, with moderate‐grade evidence for the reduction of CRI occurrence compared with standard care. Further, NST introduction significantly reduced metabolic complications, mortality, and inappropriate PN use.