1150 Safety, Feasibility, and Cost-Effectiveness of Pediatric Gastrointestinal Procedures at an Outpatient Endoscopy Center

Abstract

INTRODUCTION: Pediatric endoscopic procedures are traditionally performed in hospital-based endoscopy centers or operating rooms due to safety concerns. However, the healthcare costs of these pediatric procedures are significantly higher in the hospital setting. Current healthcare environment necessitates safe, effective, and a cost-effective approach for pediatric endoscopic procedures. We implemented specific patient selection criteria for pediatric gastrointestinal procedures at our ambulatory endoscopy center. We report 15-month data on the safety and feasibility of performing pediatric gastrointestinal procedures at an outpatient endoscopy center. We also evaluated the cost of these procedures at our center compared to the hospital-based endoscopy centers. METHODS: We conducted a retrospective chart analysis of pediatric endoscopic procedures performed at our ambulatory center over the last 15 months (February 2018 to May 2019). Sedation was provided by certified registered nurse anesthetists using propofol. We used inclusion and exclusion criteria as defined by our QA committee. In addition to standard adult criteria for endoscopy, pediatric-specific criteria included: age >6 years, weight > 22kg, avoidance of documented anaphylactic reaction to soy or egg, and inclusion of ASA I or II only. Adverse events were defined as cardio-respiratory distress indicated by use of the bag and mask ventilation, airway intubation or transfer to a hospital due to respiratory distress. Cost analysis data were obtained from the NC Blue Cross Blue Shield treatment cost estimator tool which is based on historical BCBSNC claims data. RESULTS: Overall 316 pediatric patients underwent procedures at our endoscopy center, of which 271 underwent upper endoscopy and 90 underwent colonoscopy. The average patient age was 13 years (range 6-20 years) and 44% were males. 38% of patients met ASA I criteria. None of the patients experienced any adverse events. The average cost of upper endoscopy with biopsy at our center was $750 (+/-100) compared to $4000 (+/-500V) at the hospital. The average cost of colonoscopy with biopsy at our center was $1250 (+/-50) compared to $5000 (+/-500) at the hospital-based endoscopy center. CONCLUSION: Performing pediatric gastrointestinal endoscopic procedures at an ambulatory center is feasible and safe, as long as appropriate patient selection criteria are used. Performing pediatric procedures at an ambulatory center is highly cost-effective compared to performing procedures at a hospital.