Comparing the Safety and Cost of Image-Guided Percutaneous Gastrostomy Tube Placement in the Outpatient Versus Overnight Observation Setting in a Single-Center Retrospective Study

Rationale and Objectives: Historically, patients undergoing image-guided percutaneous gastrostomy tube placement have been admitted overnight with feeds commencing 12-24 hours postprocedure. With new expedited feeding protocols starting 3-4 hours postprocedure, same-day discharge is now possible. The purpose of this study was to evaluate the safety and cost of image-guided percutaneous gastrostomy tube placement as an outpatient procedure. Materials and Methods: In this retrospective study, 131 patients (age 63.9 +/- 11.6; 34% female) underwent gastrostomy tube placement as an outpatient procedure with expedited feeding protocol versus 40 patients (age 61.3 +/- 12.6; 38% female) who were hospitalized overnight with feeds starting at 12-24 hours, primarily based on operator preference. The two groups were compared regarding complications within 90 days of procedure. Using a subgroup of 33 consecutive patients, procedural costs (total combined insurer and patient payments for professional and hospital services) for outpatients vs. hospitalized patients were compared. Results: Complication rates were similar (p = 0.64) for gastrostomy tubes placed on outpatients (0.17 complications/procedure: 4 bleeding, 2 aspiration pneumonia, 1 abdominal abscess, 4 significant pain, 6 cellulitis, 1 surgical consult, 4 malpositioned/fractured tubes) and hospitalized patients (0.20 complications/procedure: 1 aspiration pneumonia, 1 significant pain, 3 cellulitis, 1 surgical consult, 2 fractured tubes). Total combined insurer and patient payments were similar ($2193/outpatient vs $2701/hospitalized patient; p= 0.52). Conclusion: Outpatient image-guided percutaneous gastrostomy tube placement with an expedited feeding protocol is a safe and costcomparable alternative to historic overnight hospitalization. Further prospective investigation with a larger sample is warranted.