REGULAR CONTENT
Final ID
647
Type
Educational Exhibit-Poster Only
Authors
E Sorra1, S Schmidt1, A Odu1, P Sutphin1, A Pillai2
Institutions
1UT Southwestern Medical Center, Dallas, TX, 2UT Health Sciences at Houston, Houston, TX
Purpose
The current practice for outpatient placement of percutaneous gastrostomy tubes (g-tubes) by interventional radiology (IR) at our institution is overnight admission and fluoroscopic g-tube check the next morning, prior to initiation of enteral feeding. Our primary objective is to examine the clinical need for routine admission and next day g-tube checks. Secondarily, we aim to quantify the potential cost savings of a policy change.
Materials & Methods
There are both IR and gastroenterology (GI) data which shows no significant difference in complication rates between same day discharge versus admission and also show safety in early enteral use of the g-tube in properly selected patients.
Results
93 outpatients who underwent new g-tube placement from 2011-2016 were included. All next day fluoroscopic g-tube tube exams were normal. Median and mean length of stay (LOS) were 1.0 and 1.6 days, respectively. 26% had a LOS >1 day: 11 related to nutrition, 7 of 11 based on high risk of re-feeding syndrome (RFS) or laboratory evidence of RFS. Excluding patients with a LOS >1 day, the mean and median cost of visit was $8,524.89 and $6,104.35, respectively.
Conclusions
We found no indication for post-procedure g-tube checks or routine admission of all patients overnight. There were no changes in patient management based on normal results of g-tube check in 100% of patients. Regarding admission, those 7.5% of patients deemed high risk or developed RFS benefited from a planned admission. One change we propose is a nutrition consultation concurrent with a pre-procedure clinic visit to identify patients at risk for RFS that would benefit from a planned admission. The potential average cost savings in eliminating all post-procedure g-tube checks as well as routine admissions in low risk patients would be $5,497.46 per patient in our population. This is based on an estimated average cost of medical supplies, procedure and fluoroscopy suite time from a representative sampling of cost data. Our results are concordant with other data from both the IR and GI literature concluding routine admission of all outpatient placements is not indicated.
Final ID
647
Type
Educational Exhibit-Poster Only
Authors
E Sorra1, S Schmidt1, A Odu1, P Sutphin1, A Pillai2
Institutions
1UT Southwestern Medical Center, Dallas, TX, 2UT Health Sciences at Houston, Houston, TX
Purpose
The current practice for outpatient placement of percutaneous gastrostomy tubes (g-tubes) by interventional radiology (IR) at our institution is overnight admission and fluoroscopic g-tube check the next morning, prior to initiation of enteral feeding. Our primary objective is to examine the clinical need for routine admission and next day g-tube checks. Secondarily, we aim to quantify the potential cost savings of a policy change.
Materials & Methods
There are both IR and gastroenterology (GI) data which shows no significant difference in complication rates between same day discharge versus admission and also show safety in early enteral use of the g-tube in properly selected patients.
Results
93 outpatients who underwent new g-tube placement from 2011-2016 were included. All next day fluoroscopic g-tube tube exams were normal. Median and mean length of stay (LOS) were 1.0 and 1.6 days, respectively. 26% had a LOS >1 day: 11 related to nutrition, 7 of 11 based on high risk of re-feeding syndrome (RFS) or laboratory evidence of RFS. Excluding patients with a LOS >1 day, the mean and median cost of visit was $8,524.89 and $6,104.35, respectively.
Conclusions
We found no indication for post-procedure g-tube checks or routine admission of all patients overnight. There were no changes in patient management based on normal results of g-tube check in 100% of patients. Regarding admission, those 7.5% of patients deemed high risk or developed RFS benefited from a planned admission. One change we propose is a nutrition consultation concurrent with a pre-procedure clinic visit to identify patients at risk for RFS that would benefit from a planned admission. The potential average cost savings in eliminating all post-procedure g-tube checks as well as routine admissions in low risk patients would be $5,497.46 per patient in our population. This is based on an estimated average cost of medical supplies, procedure and fluoroscopy suite time from a representative sampling of cost data. Our results are concordant with other data from both the IR and GI literature concluding routine admission of all outpatient placements is not indicated.