Emergency department utilization following pediatric gastrostomy tube placement is driven by a small cohort of patients
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In brief
In brief
This retrospective study of 189 pediatric gastrostomy tube patients reveals that 24% of patients account for 82% of emergency department visits, primarily due to tube dislodgement. High ED utilizers were more likely to be non-Caucasian and required significantly more radiographic studies and healthcare charges, suggesting targeted education and outpatient support could reduce resource consumption.
Written by the GCMD Library team from the article.
Abstract
Purpose
Pediatric gastrostomy tubes (G-tubes) are associated with frequent postoperative problems and consumption of healthcare resources. We hypothesized that a small cohort of patients disproportionately drives healthcare resource utilization after G-tube insertion. This study aimed to characterize this population in order to implement evidence-based pathways to reduce healthcare utilization after G-tube insertion.
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, emergency department (ED) visits, hospital admissions, procedures, and diagnoses was abstracted. Encounter specific charges based on CPT codes were collected. Statistical analyses were performed with Mann Whitney U, Fisher's Exact Test, and multivariate nominal logistic regression. Institutional review board approval was obtained.
Results
During the study period, 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 cohort of high ED utilizers 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. Multivariate analyses demonstrated high ED utilization was significantly associated with non-Caucasian race and the surgeon performing the procedure.
Conclusions
At our institution, a significant proportion of healthcare utilization following G-tube placement is consumed by a relatively small cohort of children. Future efforts will target patients with two or more G-tube related ED visits or an early G-tube dislodgement for additional education and integration with outpatient resources.
Type of study
Retrospective study.
Level of evidence
Level II.