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Moyer AM, Abbitt D, Choy K, Jones TS, Morin TL, Wikiel KJ, Barnett CC, Moore JT, Robinson TN, Jones EL. A dedicated feeding tube clinic reduces emergency department utilization for gastrostomy tube complications. Surg Endosc 2022; 36:6969-6974. [PMID: 35132448 DOI: 10.1007/s00464-022-09065-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Enteral access is required for a variety of reasons from neuromuscular disorders to dysphagia. Gastrostomy tubes (GTs) can be placed endoscopically, surgically, or radiographically and complications include infection, bleeding, leakage and unintentional removal. Routine post-procedural follow-up is limited by inconsistent guidelines and management by different specialty teams. We established a dedicated GT clinic to provide continuity of care and prophylactic GT exchange. We hypothesized that patients followed in the GT clinic would have reduced Emergency Department (ED) utilization. METHODS A retrospective review of patients who underwent GT placement from January 2010 to January 2020 was conducted. Baseline demographics, indications for GT placement, number and reason for ED visits and utilization of a multidisciplinary GT clinic were studied. RESULTS A total of 97 patients were included. The most common indication for placement was dysphagia (88, 91%) and the most common primary diagnosis was head and neck malignancy (51, 51%). The GT clinic is a multidisciplinary clinic staffed by surgeons and residents, dieticians, and wound care specialists and cared for 16 patients in this study. Three patients (19%) in the GT clinic group required ED visits compared to 44 (54%) in the standard of care (SOC) group (p < 0.05). There was an average of 0.9 ED visits per patient (range 0-7) in the GT clinic group vs 1.6 ED visits per patient (range 0-20) in the SOC group (p = 0.34). Feeding tubes were prophylactically exchanged an average of 7 times per patient in the GT clinic group vs 3 times per patient in the SOC group (p < 0.05). CONCLUSION A multidisciplinary clinic dedicated to GT care limits ED visits for associated complications by more than 50%. Follow-up in a dedicated clinic with prophylactic tube exchange decreases ED visits and should be considered at facilities that care for patients with GTs.
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Affiliation(s)
- Amber M Moyer
- Department of Surgery, University of Colorado School of Medicine & Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA.
| | - Danielle Abbitt
- Department of Surgery, University of Colorado School of Medicine & Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA
| | - Kevin Choy
- Department of Surgery, University of Colorado School of Medicine & Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA
| | - Teresa S Jones
- Department of Surgery, University of Colorado School of Medicine & Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA
| | - Theresa L Morin
- Department of Surgery, University of Colorado School of Medicine & Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA
| | - Krzystof J Wikiel
- Department of Surgery, University of Colorado School of Medicine & Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA
| | - Carlton C Barnett
- Department of Surgery, University of Colorado School of Medicine & Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA
| | - John T Moore
- Department of Surgery, University of Colorado School of Medicine & Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA
| | - Thomas N Robinson
- Department of Surgery, University of Colorado School of Medicine & Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA
| | - Edward L Jones
- Department of Surgery, University of Colorado School of Medicine & Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA
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Jones TS, Jones EL, Richardson V, Finley JB, Franklin JL, Gore DL, Horney CP, Kovar A, Morin TL, Robinson TN. Preliminary data demonstrate the Geriatric Surgery Verification program reduces postoperative length of stay. J Am Geriatr Soc 2021; 69:1993-1999. [PMID: 33826150 DOI: 10.1111/jgs.17154] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/26/2021] [Accepted: 03/19/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES/BACKGROUND The Geriatric Surgery Verification (GSV) Program promotes clinical standards aimed to optimize the quality of surgical care delivered to older adults. The purpose of this study was to determine if preliminary implementation of the GSV Program standards improves surgical outcomes. DESIGN Prospective study with cohort matching. SETTING Data from a single institution compared with a national data set cohort. PARTICIPANTS All patients aged ≥75 years undergoing inpatient operations between January 2018 and December 2019 were included. Cohort matching by age and procedure code was performed using a national data set. MEASUREMENTS Baseline pre- and intraoperative characteristics prospectively recorded using Veterans Affairs Surgical Quality Improvement Program (VASQIP) variable definitions. Postoperative outcomes were recorded including complications as defined by VASQIP, 30-day mortality, and length of stay. RESULTS A total of 162 patients participated in the GSV program, and 308 patients comprised the matched comparison group. There was no difference in postoperative occurrence of one or more complications (p = 0.81) or 30-day mortality (p = 0.61). Patients cared for by the GSV Program had a reduced postoperative length of stay (median 4 days [range 1,31] vs. 5 days [range 1,86]; p < 0.01; and mean 5.4 ± 4.8 vs. 8.8 ± 11.8 days; p < 0.01) compared with the matched cohort. In a multivariable regression model, the GSV Program's reduced length of stay was independent of other associated covariates including age, operative time, and comorbidities (p < 0.01). CONCLUSION Preliminary implementation of the GSV Program standards reduces length of stay in older adults undergoing inpatient operations. This finding demonstrates both the clinical and financial value of the GSV Program.
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Affiliation(s)
- Teresa S Jones
- Department of Surgery, Rocky Mountain Regional Veterans Affairs Medical Center, VA Eastern Colorado Health Care System, Aurora, Colorado, United States.,Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, United States.,Rocky Mountain Regional Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, United States
| | - Edward L Jones
- Department of Surgery, Rocky Mountain Regional Veterans Affairs Medical Center, VA Eastern Colorado Health Care System, Aurora, Colorado, United States.,Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Vanessa Richardson
- Rocky Mountain Regional Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, United States
| | - Julie B Finley
- Department of Surgery, Rocky Mountain Regional Veterans Affairs Medical Center, VA Eastern Colorado Health Care System, Aurora, Colorado, United States
| | - Jennifer L Franklin
- Department of Surgery, Rocky Mountain Regional Veterans Affairs Medical Center, VA Eastern Colorado Health Care System, Aurora, Colorado, United States
| | - Deborah L Gore
- Department of Surgery, Rocky Mountain Regional Veterans Affairs Medical Center, VA Eastern Colorado Health Care System, Aurora, Colorado, United States
| | - Carolyn P Horney
- Geriatrics Section, Department of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, VA Eastern Colorado Health Care System, Aurora, Colorado, United States
| | - Alexandra Kovar
- Department of Surgery, Rocky Mountain Regional Veterans Affairs Medical Center, VA Eastern Colorado Health Care System, Aurora, Colorado, United States.,Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Theresa L Morin
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Thomas N Robinson
- Department of Surgery, Rocky Mountain Regional Veterans Affairs Medical Center, VA Eastern Colorado Health Care System, Aurora, Colorado, United States.,Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, United States
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