3:27 PM Abstract No. 114 Nationwide trends in pediatric percutaneous kidney and liver biopsies: is there a value proposition for interventional radiologists who can safely perform these procedures as outpatients?

Abstract

To investigate trends, costs, relative safety, and potential savings of inpatient versus outpatient percutaneous kidney and liver biopsies in the pediatric population. Data on admission type and cost (using billed charges as a cost-surrogate) from all percutaneous kidney and liver biopsies performed from 2008-2015 was collected using the Pediatric Health Information System (PHIS), a comparative database of patient encounters from 44 US Children’s Hospitals. Regression analysis was performed to evaluate the annual trend in the biopsy patients admitted as inpatients vs outpatients. Costs were compared using the Tukey-Kramer Method (significance: p < 0.05). To assess safety of outpatient biopsies performed by interventional radiology (IR), data was collected on all percutaneous kidney and liver biopsies performed at a single, large tertiary care children’s hospital (“Hospital A”) from 2014-2017, using complications requiring escalation in care (SIR Classifications B-F) as a surrogate for safety. 7,835 kidney and 9,984 liver biopsies were performed by all specialties at all PHIS hospitals. Regression analysis showed a significant annual decline in percentage of kidney (-0.6%, p = 0.008) and liver (-3.0%, p = 0.01) biopsies. Notably, > 15% and >10% of kidney and liver biopsies were still performed as inpatients as of 2015, respectively. Costs were significantly (p < 0.0001) higher for inpatient biopsies (mean: $65,872 + $201,572 for kidney, mean: $173,331+ $505,177 for liver) vs outpatients (mean: $13,410 + $7,385 kidney, mean: $10,338+ $7,273 liver). 223 kidney biopsies and 441 liver biopsies were performed on outpatients from 2014-17 by IR at Hospital A. Percutaneous kidney biopsy complication rate = 1.3% (1 SIR class C, 2 SIR class D). Percutaneous liver biopsy complication rate = 0.2% (1 SIR Class C). A substantial percentage of pediatric patients are still admitted as inpatients for postprocedure monitoring following percutaneous kidney and liver biopsies. Our study shows that these procedures can be done safely by IRs as outpatients, offering substantial potential cost savings for healthcare systems.