Lauren Marie Brubaker Burke MD, Presenter: Nothing to Disclose

Mustafa Rifaat Bashir MD, Abstract Co-Author: Research support, Bracco Group Research support, Siemens AG Consultant, Bayer AG Consultant, Siemens AG

Carly Susan Gardner MD, Abstract Co-Author: Nothing to Disclose

Arthur Arta Parsee MD, Abstract Co-Author: Nothing to Disclose

Daniele Marin MD, Abstract Co-Author: Nothing to Disclose

David Paul Alexander Vermess MD, Abstract Co-Author: Nothing to Disclose

Syamal D. Bhattacharya, Abstract Co-Author: Nothing to Disclose

Tracy Anne Jaffe MD, Abstract Co-Author: Nothing to Disclose

To identify differences in hospital course and overall treatment cost when comparing CT-guided percutaneous drainage with open surgical repair for gastrointestinal anastomotic leaks.

A retrospective IRB-approved search using key words “leak” and/or “anastomotic” was performed on all adult chest, abdomen, and pelvis CT reports between January 1, 2002, and July 11, 2011. CT examinations were independently reviewed by three radiologists for the presence of a leak with a confidence score of 1-5 (1=no leak, 5=definite leak). Patients with confidence scores ≥ 4 were included for review. Patient demographics, method of leak management, number of hospital admissions, length of stay, discharge disposition, number of CT examinations, and number of drains (surgical or percutaneous) were collected. Total medical costs were compared for all patients treated after 2006. Statistical analysis was performed with Chi-square and Mann-Whitney-U tests.

144 patients had radiographic evidence of a gastrointestinal anastomotic leak (esophageal, gastric, small or large bowel). 54 patients underwent surgical repair of their anastomotic leaks; 9 were excluded due to leak confidence scores ≤ 3, resulting in 45 patients in Group A. Ninety patients (Group B) underwent CT-guided percutaneous drainage. When comparing Groups A and B, there was no statistical difference in patient demographics, number of hospital admissions, number of CT scans, discharge disposition, or number of drains. Patients in Group A had longer hospital stays compared to Group B (44.3 days versus 27.7 days, p<0.0001). 109 patients had cost data available for analysis. There was a statistically significant difference in overall cost of hospitalization, with the cost for surgically managed patients averaging approximately $40,000 more than for patients managed only by percutaneous drainage ($101,251 vs. $61,045, p = 0.007).

Gastrointestinal anastomotic leaks managed by percutaneous drainage are associated with lower overall cost and shorter hospital stays compared with open surgical management.

Evidence supporting the use of percutaneous CT-guided drainage for gastrointestinal anastomotic leaks over open surgical management.

Burke, L, Bashir, M, Gardner, C, Parsee, A, Marin, D, Vermess, D, Bhattacharya, S, Jaffe, T, CT-guided Percutaneous Drainage versus Surgical Repair of Gastrointestinal Anastomotic Leaks: Is There a Difference in Hospital Course or Overall Treatment Cost?.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13015213.html