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Cost and safety of pediatric intensive care physician-placed broviac catheters
Robert K Fitzgerald1, Jennifer C Yu, Surender Rajasekaran
11Pediatric Intensive Care Unit, Helen DeVos Children's Hospital, Grand Rapids, MI. 2Pediatric Emergency Medicine, Children's Hospital of Michigan, Detroit, MI. 3Department of Pediatric Surgery, Helen DeVos Children's Hospital, Grand Rapids, MI.
Insights
Pediatric intensivists can safely place Broviac catheters in a sedation suite, matching surgeon safety outcomes. This approach significantly reduces procedure costs for pediatric patients.
Area of Science:
- Pediatric critical care
- Surgical procedures
- Healthcare economics
Background:
- Broviac catheters are essential for long-term venous access in pediatric patients.
- Traditionally, placement is performed by pediatric surgeons in operating rooms.
- Alternative, potentially lower-cost, and equally safe methods are being explored.
Purpose of the Study:
- To compare the safety and cost-effectiveness of Broviac catheter placement by pediatric intensivists versus pediatric surgeons.
- To evaluate immediate, short-term, and long-term outcomes for both procedures.
- To analyze the financial implications of each placement method.
Main Methods:
- Single-center retrospective analysis of 253 pediatric patients.
- Comparison of procedures performed by pediatric intensivists in a sedation suite and pediatric surgeons in an operating room.
- Assessment of safety outcomes (complications, infections, malfunctions) and cost data.
Main Results:
- No significant differences in immediate, short-term, or long-term safety outcomes between intensivists and surgeons.
- Significantly lower overall cost for Broviac catheter placement by intensivists ($3,565) compared to surgeons ($7,031).
- Procedure failure and anesthetic complications were not statistically different between groups.
Conclusions:
- Pediatric critical care physicians can perform Broviac catheter placements with comparable safety to pediatric surgeons.
- Placement in a sedation suite by intensivists offers a significantly more cost-effective alternative.
- This finding supports the expanded role of intensivists in managing central venous access devices for pediatric patients.
Objective:
To compare the cost and safety of placement of Broviac catheters in children by pediatric intensivists in a sedation suite versus placement by pediatric surgeons in the operating room.
Design:
Single-center retrospective analysis.
Setting:
Pediatric sedation suite and operating rooms in a tertiary care children's hospital.
Patients:
All pediatric patients with Broviac catheters placed (n = 253) at this institution over a 3-year period from 2007 to 2009.
Interventions:
None.
Measurements And Main Results:
We reviewed the charts of all pediatric patients with Broviac catheters placed, either by intensivists or surgeons, and compared cost and outcomes. Procedure safety was assessed and categorized into immediate, short-term (within 2 wk of procedure), and long-term outcomes. Anesthetic safety and billing data for the procedure were also collected. Among similar patient populations, immediate complications, such as pneumothorax, procedure failure (p > 0.999), and anesthetic complications (p = 0.60), were not significantly different. Short-term outcomes, including infection (p = 0.27) and catheter malfunction (p > 0.999), were not different. Long-term outcomes, including mean indwelling catheter days (p = 0.60) and removal due to catheter infection (p = 0.09), were not different between the groups. Overall cost of the procedure was significantly different: $7,031 (± $784) when performed by surgeons and $3,565 (± $311) when performed by intensivists (p < 0.001).
Conclusions:
Pediatric critical care physicians can place Broviac catheters as safely as pediatric surgeons and at a lower cost in a defined patient population.
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