Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jun 16, 2022; 14(6): 367-375
Published online Jun 16, 2022. doi: 10.4253/wjge.v14.i6.367
Pediatric endoscopy across multiple clinical settings: Efficiency and adverse events
Erin Crawford, Ramy Sabe, Thomas J Sferra, Carolyn Apperson-Hansen, Ali S Khalili
Erin Crawford, Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH 44113, United States
Ramy Sabe, Thomas J Sferra, Ali S Khalili, Department of Pediatric Gastroenterology, Hepatology and Nutrition, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH 44106, United States
Carolyn Apperson-Hansen, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH 44106, United States
Author contributions: Crawford E, Sabe R, Sferra TJ, Apperson-Hansen C, and Khalili AS contributed equally to this work; Crawford E, Sabe R, Sferra TJ, Apperson-Hansen C, and Khalili AS designed the research study; Crawford E and Khalili AS performed the research; Crawford E and Apperson-Hansen C analyzed the data; Crawford E, Sabe R, Sferra TJ, Apperson-Hansen C, and Khalili AS wrote the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of the University Hospitals (No. CR00002806).
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data sharing is not permitted for this study.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ali S Khalili, MD, Assistant Professor, Department of Pediatric Gastroenterology, Hepatology and Nutrition, University Hospitals Rainbow Babies and Children's Hospital, 11100 Euclid Ave. Suite 737, Cleveland, OH 44106, United States. ali.khalili@uhhospitals.org
Received: September 1, 2021
Peer-review started: September 1, 2021
First decision: March 15, 2022
Revised: March 29, 2022
Accepted: May 22, 2022
Article in press: May 22, 2022
Published online: June 16, 2022
Processing time: 284 Days and 15.8 Hours
Abstract
BACKGROUND

Endoscopic procedures are becoming increasingly important for the diagnosis and treatment of gastrointestinal disorders during childhood, and have evolved from a more infrequent inpatient procedure in the operating room to a routine outpatient procedure conducted in multiple care settings. Demand for these procedures is rapidly increasing and thus there is a need to perform them in an efficient manner. However, there are little data comparing the efficiency of pediatric endoscopic procedures in diverse clinical environments. We hypothesized that there are significant differences in efficiency between settings.

AIM

To compare the efficiency and examine adverse effects of pediatric endoscopic procedures across three clinical settings.

METHODS

A retrospective chart review was conducted on 1623 cases of esophagogastroduodenoscopy (EGD) or combined EGD and colonoscopy performed between January 1, 2014 and May 31, 2018 by 6 experienced pediatric gastroenterologists in three different clinical settings, including a tertiary care hospital operating room, community hospital operating room, and free-standing pediatric ambulatory endoscopy center at a community hospital. The following strict guidelines were used to schedule patients at all three locations: age greater than 6 mo; American Society of Anesthesiologists class 1 or 2; normal craniofacial anatomy; no anticipated therapeutic intervention (e.g., foreign body retrieval, stricture dilation); and, no planned or anticipated hospitalization post-procedure. Data on demographics, times, admission rates, and adverse events were collected. Endoscopist time (elapsed time from the endoscopist entering the operating room or endoscopy suite to the next patient entering) and patient time (elapsed time from patient registration to that patient exiting the operating room or endoscopy suite) were calculated to assess efficiency.

RESULTS

In total, 58% of the cases were performed in the tertiary care operating room. The median age of patients was 12 years and the male-to-female ratio was nearly equal across all locations. Endoscopist time at the tertiary care operating room was 12 min longer compared to the community operating room (63.3 ± 21.5 min vs 51.4 ± 18.9 min, P < 0.001) and 7 min longer compared to the endoscopy center (vs 56.6 ± 19.3 min, P < 0.001). Patient time at the tertiary care operating room was 11 min longer compared to the community operating room (133.2 ± 39.9 min vs 122.3 ± 39.5 min, P < 0.001) and 9 min longer compared to the endoscopy center (vs 124.9 ± 37.9 min; P < 0.001). When comparing endoscopist and patient times for EGD and EGD/colonoscopies among the three locations, endoscopist, and patient times were again shorter in the community hospital and endoscopy center compared to the tertiary care operating room. Adverse events from procedures occurred in 0.1% (n = 2) of cases performed in the tertiary care operating room, with 2.2% (n = 35) of cases from all locations having required an unplanned admission after the endoscopy for management of a primary GI disorder.

CONCLUSION

Pediatric endoscopic procedures can be conducted more efficiently in select patients in a community operating room and endoscopy center compared to a tertiary care operating room.

Keywords: Pediatric endoscopy; Efficiency; Adverse events; Tertiary care operating room; Community operating room; Endoscopy center

Core Tip: This was a retrospective study where we compared the efficiency of pediatric endoscopic procedures in a tertiary care operating room, community operating room, and endoscopy center and secondarily examined adverse events of procedures across these settings. We found that with using strict, identical scheduling guidelines for all locations, undergoing esophagogastroduodenoscopy (EGD) or combined EGD and colonoscopy at the community hospital room and endoscopy center was significantly faster for the patient and endoscopist when compared to the tertiary care operating room. The rate of adverse events was similar across all three locations.