L. I. Ruffolo1, A. McGuire1, K. Wolcott2, H. Martin1, M. Pulhamus1, C. Gitzelmann3, W. Pegoli1, D. S. Wakeman1 1University Of Rochester,Surgery,Rochester, NY, USA 2Rochester Regional Health,Surgery,Rochester, NY, USA 3Robert Wood Johnson – UMDNJ,Surgery,New Brunswick, NJ, USA
Introduction: Pediatric gastrostomy tubes (G tubes) have been associated with frequent healthcare utilization. Little is known regarding patient specific utilization over time and the financial impact of emergency department (ED) visits. We hypothesized that a small cohort of these patients disproportionately over utilize health care resources after G tube insertion. This project aimed to characterize this population in order to implement evidence-based pathways for re-engaging patient caretakers, in an effort to prevent unnecessary emergency department utilization and reduce exposure to radiographic studies.
Methods: All surgically placed pediatric G tubes at a quaternary care center between March 2011 and June 2018 were retrospectively reviewed. Healthcare utilization including radiographic studies, ED visits, electronic encounters, clinic encounters and diagnoses were abstracted. Encounter specific charges based on CPT codes were collected. Statistical analyses were performed with Mann Whitney U, Chi Square, and univariate logistic regression. Institutional review board approval was obtained.
Results: 189 patients underwent G tube insertion. 24% of patients presented to the ED two or more times and accounted for 82% of ED visits. This high ED utilizer population was more likely to present with G tube dislodgement [both within the first three months (early) and after three months (late)], required more radiographic studies, and accrued significantly more charges compared to low ED utilizers (Table). The low ED utilizers were more likely to present to outpatient clinics for G tube related complaints or call ahead prior to presenting to the ED. Univariate regressions demonstrated a statistically significant association between African American race, neonate at time of surgery, and history of bronchopulmonary dysplasia with high ED utilizers.
Conclusion: At our institution, a significant proportion of healthcare utilization following G tube placement is consumed by a relatively small population. Future efforts will identify patients after a second G-tube related ED visit for additional education and integration with outpatient resources.
