Image-guided percutaneous drainage vs. surgical repair of gastrointestinal anastomotic leaks: is there a difference in hospital course or hospitalization cost?

PURPOSE: To identify differences in hospital course and hospitalization cost when comparing image-guided percutaneous drainage with surgical repair for gastrointestinal anastomotic leaks. MATERIALS AND METHODS: A retrospective IRB-approved search using key words "leak" and/or "anastomotic" was performed on all adult CT reports from 2002 to 2011. CT examinations were reviewed for evidence of a postoperative gastrointestinal leak and assigned a confidence score of 1-5 (1 = no leak, 5 = definite leak). Patients with an average confidence score <4 were excluded. Type of surgery, patient data, method of leak management, number of hospital admissions, length of hospital stay, discharge disposition, number of CT examinations, number of drains, and hospitalization costs were collected. RESULTS: One hundred thirty-nine patients had radiographic evidence of a gastrointestinal anastomotic leak (esophageal, gastric, small bowel or colonic). Nine patients were excluded due to low confidence scores. Twenty-seven patients underwent surgical repair (Group A) and 103 were managed entirely with percutaneous image-guided drainage (Group B). There was no significant difference in patient demographics or number of hospital admissions. Patients in Group A had longer median hospital stays compared to Group B (48 vs. 32 days, p = 0.007). The median total hospitalization cost for Group A was more than twice that for Group B ($99,995 vs. $47,838, p = 0.001). Differences in hospital disposition, number of CT examinations, number of drains, and time between original surgery and first CT examination were statistically significant. CONCLUSION: Gastrointestinal anastomotic leaks managed by percutaneous drainage are associated with lower hospital cost and shorter hospital stays compared with surgical management.

Normal pediatric prevertebral soft-tissue thickness on MDCT.

OBJECTIVE: The thickness of the prevertebral soft tissue (PVST) is instrumental in helping detect cervical spine injuries in the pediatric population. Current parameters for normal PVST thickness in that population are based on lateral radiographs because there have been no studies to date defining age-dependent normal measurements on MDCT. With the increasingly important role of MDCT in the evaluation of pediatric trauma patients, it is necessary to establish normal values for pediatric PVST thickness on MDCT images. Thus, the purpose of this study is to establish the normal thickness of PVST on MDCT of the pediatric population from 0 to 15 years old. MATERIALS AND METHODS: The thickness of the PVST was measured in 139 pediatric trauma patients (age range 0-15 years) who presented to the pediatric emergency department between 2005 and 2008. Patients included in the study were not intubated, had no congenital or acquired osseous abnormality detected on CT, and were discharged from the hospital without a diagnosis of cervical spine or soft-tissue injury. Exclusion criteria included patients with concurrent injury found on head CT or nontraumatic causes of PVST thickening, such as lymphadenopathy or retropharyngeal internal carotid arteries. Patients who were diagnosed with cervical injuries within 1 year after the initial CT examination were also excluded. Each patient was scanned with a cervical collar placing the cervical spine in a neutral or near-neutral position. RESULTS: The smallest variability and calculated SD were at C2 and C6. The upper limits of normal for PVST thickness at C2 were 7.6 mm in patients from 0 to 2 years old, 8.4 mm in patients from 3 to 6 years old, and 6.8 mm in patients from 7 to 10 years old and in those from 11 to 15 years old. At the C6 level, the upper limits were 9.0 mm in patients from 0 to 2 years old, 9.8 mm in patients from 3 to 6 years old, 12.1 mm in patients from 7 to 10 years old, and 14.5 mm in patients from 11 to 15 years old. The upper limit of normal had the highest variability at C3 and C4 for all age groups. CONCLUSION: The thickness of the PVST is important in the detection of underlying injuries to the cervical spine. MDCT is playing an increasingly important role in the evaluation of pediatric trauma patients. We propose the obtained values as the upper limits of normal for PVST thickness on MDCT images in the pediatric population from 0 to 15 years old.