Comparing the Safety and Cost of Image-Guided Percutaneous Gastrostomy Tube Placement in the Outpatient Versus Overnight Observation Setting in a Single-Center Retrospective Study.

Autor:	Dolan RS; Emory University Department of Radiology, Emory University Hospital, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322. Electronic address: ryan.dolan@emory.edu., Duszak R Jr; Emory University Department of Radiology, Emory University Hospital, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322., Bercu ZL; Emory University Department of Radiology, Emory University Hospital, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322., Martin JG; Duke University Department of Radiology, Duke University School of Medicine, Durham, North Carolina., Newsome J; Emory University Department of Radiology, Emory University Hospital, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322., Kokabi N; Emory University Department of Radiology, Emory University Hospital, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322.
Jazyk:	angličtina
Zdroj:	Academic radiology [Acad Radiol] 2021 Aug; Vol. 28 (8), pp. 1081-1085. Date of Electronic Publication: 2020 Jun 09.
DOI:	10.1016/j.acra.2020.04.044
Abstrakt:	Rationale and Objectives: Historically, patients undergoing image-guided percutaneous gastrostomy tube placement have been admitted overnight with feeds commencing 12-24 hours postprocedure. With new expedited feeding protocols starting 3-4 hours postprocedure, same-day discharge is now possible. The purpose of this study was to evaluate the safety and cost of image-guided percutaneous gastrostomy tube placement as an outpatient procedure. Materials and Methods: In this retrospective study, 131 patients (age 63.9 ± 11.6; 34% female) underwent gastrostomy tube placement as an outpatient procedure with expedited feeding protocol versus 40 patients (age 61.3 ± 12.6; 38% female) who were hospitalized overnight with feeds starting at 12-24 hours, primarily based on operator preference. The two groups were compared regarding complications within 90 days of procedure. Using a subgroup of 33 consecutive patients, procedural costs (total combined insurer and patient payments for professional and hospital services) for outpatients vs. hospitalized patients were compared. Results: Complication rates were similar (p = 0.64) for gastrostomy tubes placed on outpatients (0.17 complications/procedure: 4 bleeding, 2 aspiration pneumonia, 1 abdominal abscess, 4 significant pain, 6 cellulitis, 1 surgical consult, 4 malpositioned/fractured tubes) and hospitalized patients (0.20 complications/procedure: 1 aspiration pneumonia, 1 significant pain, 3 cellulitis, 1 surgical consult, 2 fractured tubes). Total combined insurer and patient payments were similar ($2193/outpatient vs $2701/hospitalized patient; p= 0.52). Conclusion: Outpatient image-guided percutaneous gastrostomy tube placement with an expedited feeding protocol is a safe and cost-comparable alternative to historic overnight hospitalization. Further prospective investigation with a larger sample is warranted. (Copyright © 2020 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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