ERS5718. Assessing Post-Operative Leak Detection Efficiency in Various Surgery Types: A Cost-Effectiveness Analysis
Authors* Denotes Presenting Author
Parvaneh Hassani;
University of California Irvine
Cameron Fateri *;
University of California Irvine
Erwin Ho;
University of California Irvine
Sai Wignarajah;
University of California Irvine
Chang Shu;
University of California Irvine
Sungmee Park;
University of California Irvine
Roozbeh Houshyar;
University of California Irvine
Objective:
The routine utilization of an upper gastrointestinal (UGI) series within a surgical/procedural admission following an upper intestinal or gastric procedure has been regarded as a diagnostic technique for the early identification of post-operative complications, including gastrointestinal leaks. However, its efficacy has been questioned in several studies. Our study's purpose is to retrospectively evaluate the fluoroscopically identified leak rate and to assess the value of routine upper GI series in the post-operative setting. Additionally, we will explore alternative approaches for triaging post-operative patients based on early signs and sepsis symptoms.
Materials and Methods:
We retrospectively analyzed data from 2,091 consecutive inpatient fluoroscopic studies performed between January 2017 and June 2023. 655 patients were excluded per inclusion/exclusion criteria and 1,436 patients who had fluoroscopic evaluations within the procedural admission at our institution were included. Demographics and surgical data were collected. Charts were reviewed to examine clinical signs including heart and respiratory rates, temperature, surgery type, blood pressure, and white blood cell count. Early clinical parameter differences were assessed between patients with gastrointestinal leak and those without using the Wilcoxon Rank Sum Test and Student’s t-test.
Results:
43 out of 1,436 individuals (2.99%) were diagnosed with post-operative leak on fluoroscopic imaging. With a 2.99% rate and an average cost of $300 for a post-operative UGI contrast study, 33 routine UGI series ($9,900 expenditure) need to be performed to detect one leak. Leak positive patients typically had higher pulse rates (93 vs. 82 bpm, <em>P</em> < 0.01) and respiratory rates (18 vs. 16 bpm, <em>P</em> < 0.01) on average. Furthermore, a comparative analysis of surgical procedures in patients with leak indicated that 41.86% underwent endoscopic procedures to treat existing leaks. In contrast, this procedure type accounted for 11% of total procedures.
Conclusion:
Our findings indicate a low percentage of post-operative patients are positive for gastrointestinal leak in the immediate post-operative setting when using routine fluoroscopy, indicating the inefficiency of reflexive fluoroscopic evaluation. Redirecting resources towards patients with early signs of septic symptoms and with a history of existing leaks repair may prove to be a more efficient and cost-effective strategy.
