POST HOC ANALYSIS OF IMPLEMENTING BEDSIDE PERCUTANEOUS ULTRASOUND GASTROSTOMY IN A CRITICAL CARE UNIT: ASSESSING ADVERSE EVENTS AND SEVERITY OF ILLNESS BETWEEN GROUPS

ABSTRACT

SESSION TITLE Late Breaking Investigations From Pulmonary and Critical Care SESSION TYPE Original Investigation Posters PRESENTED ON 10/18/2022 0130 pm - 0230 pm PURPOSE: Critical care patients receive over 50% of gastrostomy tubes placed in the United States. Studies support performing concomitant tracheostomy and gastrostomy to improve efficiencies in care and reduce healthcare costs. Prior research has supported the safe performance of Percutaneous Ultrasound Gastrostomy (PUG) by interventional radiologists. Our recent study, Length of Stay and Hospital Cost Reductions After Implementing Bedside Percutaneous Ultrasound Gastrostomy (PUG) in a Critical Care Unit, demonstrated that PUG placement by ICU physicians in patients with ventilator-dependent respiratory failure significantly reduced ICULOS and hospital LOS by 5 and 8 days respectively, and total hospital costs by $26,621 per patient. 70% of PUG procedures were performed concomitantly with tracheostomy (TPUG), compared to 0 in the usual care gastrostomy group. We now report a post hoc safety analysis assessing adverse events and patient comorbidity between these groups. METHODS: Post hoc analysis was performed on a retrospective cohort of patients with ventilator-dependent respiratory failure, grouped by those who received a gastrostomy consultation with gastroenterology or interventional radiology (usual care) and those who received a bedside PUG by a critical care physician. Adverse events related to gastrostomy placement were compared between groups using Fisher’s Exact tests. Charlson Scores were calculated for each patient and compared, as well as for the subgroup of patients with adverse events, using Student’s t-tests. RESULTS: There were 43 patients in the usual care group and 45 in the PUG group. Adverse events (AEs) in the usual care group totaled 16;7 major and 9 minor. AEs in the PUG group totaled 13;5 major and 8 minor. There were no significant differences between groups related to AEs (p=0.498). 28 of the usual care patients and 31 of the PUG patients were COVID-19 positive, respectively (p=0.71). The usual care and PUG groups had average Charlson scores of 2.88 (SD 2.13) and 3.23 (SD 2.32), respectively (p=0.537). The subgroup of patients with complications in each group had statistically equivalent Charlson scores (p=0.624). CONCLUSIONS: Our analysis demonstrates no difference in adverse events between PUG and usual care. PUG may be safely performed by Critical Care physicians at the bedside and in combination with tracheostomy. Performing PUG as the initial gastrostomy option in ventilatory-dependent patients decreases LOS and total hospital costs, without negatively affecting procedural adverse events. CLINICAL IMPLICATIONS This research supports PUG as a safe method of gastrostomy placement by Critical Care physicians which may be performed at the bedside concomitantly to tracheostomy, driving reductions in ICULOS, hospital LOS, and total hospital costs per patient, with no significant increase in adverse events. DISCLOSURES No relevant relationships by Jason Heavner No relevant relationships by Jeffrey Marshall No relevant relationships by Peter Olivieri No relevant relationships by Janelle Thomas No relevant relationships by Hannah Van Ryzin No relevant relationships by R. Gentry Wilkerson