The financial impact of flipping the coin

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• 作者：Katherine W. Gonzalez ; Shiva R. Reddy ; Angela A. Mundakkal ; Shawn D. St. Peter ; ^{sspeter@cmh.edu}
• 关键词：Esophageal foreign body ; Coin ; Retrieval ; Extraction
• 刊名：Journal of Pediatric Surgery
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：52
• 期：1
• 页码：153-155
• 全文大小：275 K
• 卷排序：52

文摘

Esophageal foreign body retrieval is typically performed by rigid or flexible esophagoscopy. Despite evidence supporting the efficacy and safety of balloon extraction, it is rarely performed. We sought to establish the financial benefits of this minimally invasive approach.MethodsA retrospective review of 241 children with esophageal coins between 2011 and 2013 was performed. Coins were removed via endoscopy or fluoroscopic-guided balloon retrieval. Timing, symptoms, facility cost, and patient charges were compared.ResultsTwo hundred patients had attempted balloon retrieval with 80% success. Forty-one patients went directly for operative removal. Patients with respiratory difficulty (p = 0.05), wheezing (p < 0.01), or fever (p = 0.03) were more often taken directly for endoscopic retrieval. The median cost and charges for attempted balloon extraction were $484 and $1647. The median cost and charges for primary endoscopy were $1834 and $6746. The median total cost and charges of attempted balloon extraction including ED, OR, transport, admission, and balloon retrieval were $1231 and $3539 versus $3615 and $12,204 in the primary endoscopy group (p < 0.001, p < 0.001). Seventeen percent of patients who underwent attempted balloon retrieval were admitted prior to removal compared to 76% who underwent primary endoscopy (p < 0.001).ConclusionsFluoroscopic guided balloon extraction of esophageal coins is a financially prudent choice which shortens hospital stay.Level of EvidenceIII.Type of StudyRetrospective treatment and economic study.