P0834 - Costs Associated With Routine Post-Procedural Surveillance Imaging After Peroral Endoscopic Myotomy: A Quality Initiative

Aimen Farooq, MD, Baha Aldeen Bani Fawwaz, MD, Arooj Mian, MD, Gurdeep Singh, DO, Peter Gerges, MD, Kambiz Kadkhodayan, MD, Deepanshu Jain, MD, Natalie Cosgrove, MD, Mustafa arain, MD, Muhammad K. Hasan, MD, Dennis Yang, MD
AdventHealth, Orlando, FL

Introduction: POEM has become the standard of care for select patients with achalasia, but there is no consensus on post-procedural care. Routine post-POEM imaging is performed to rule out adverse events, yet the clinical utility of this approach remains questionable. The aim of this study was to evaluate costs associated with routine imaging and its impact on patient care and hospital length of stay (LOS).




Methods: Prospective data collection and analysis of consecutive patients who underwent POEM between December 2021 to July 2022. At the time, our post-procedural care protocol (Fig 1) involved routine imaging (CT esophagram or upper gastrointestinal [UGI] series) to evaluate for adverse events, specifically for contrast extravasation to suggest a leak/perforation. Patients were kept nil per os (NPO) until results were available and extravasation ruled out. Diet was then advanced, and patients discharged on antibiotics for 5 days and proton-pump inhibitor for 30 days. The primary aim was to assess the cost of routine post-POEM imaging and hospitalization. Secondary aims included the time of post-procedural imaging and its impact on NPO status and LOS. Imaging results occurring after 12 PM on POD#1 were considered delayed.




Results: 22 consecutive patients (mean age 56.2 years, 50% women), mean baseline Eckardt of 6.6±2.4 and integrated relaxation pressure (IRP) of 27.1±8.0 underwent POEM during the study period. Routine imaging (CT esophagram n=20, UGI series n=2) was performed in all patients. None of the studies showed contrast extravasation. The mean cost of imaging was $2493±645. More than half the patients (13/22;59%) had delayed imaging results: after 12 PM on POD#1 (n=10), POD#2 (n=2), and POD#3 (n=1). Mean LOS was 1.4±0.6 days, with 7 patients (32%) staying between 2 (n=6) or 3 (n=1) days total. Out of these 7 patients, 3 had prolonged LOS beyond POD#1 due to delays in the completion of the imaging studies. The mean total cost of hospital stay and patient charges were $7,209±2766 and $38,705±8013.8, respectively. All patients reported clinical response (mean Eckardt score 0.8±1.6) and no interim adverse events at a median of 1-month follow-up.

Discussion: Routine post-POEM imaging is associated with considerable costs and delays in oral intake and hospital discharge. As a result of this quality initiative, we no longer perform routine imaging after POEM but have developed a risk stratification system for patient care with the goal of subsequent validation in a multicenter prospective trial.




Disclosures:


Aimen Farooq, MD, Baha Aldeen Bani Fawwaz, MD, Arooj Mian, MD, Gurdeep Singh, DO, Peter Gerges, MD, Kambiz Kadkhodayan, MD, Deepanshu Jain, MD, Natalie Cosgrove, MD, Mustafa arain, MD, Muhammad K. Hasan, MD, Dennis Yang, MD. P0834 - Costs Associated With Routine Post-Procedural Surveillance Imaging After Peroral Endoscopic Myotomy: A Quality Initiative, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.