S L Poris, MD1, A J Fontaine, BS2, J E Glener, BS2, S A Kubovec, MS2, P Veldhuis, BS1, Y Du, MS1, J Pepe, PhD1, W S Eubanks, MD1. 1Institute for Surgical Advancement, Florida Hospital Orlando, FL, 2University of Central Florida College of Medicine, Orlando, FL
Background There are currently no evidence-based guidelines on the routine or selective use of radiologic imaging after omental patch repair (OPR) of a gastric (GP) or duodenal perforation (DP). This study aims to elucidate whether the use of selective or routine contrast upper gastrointestinal series (UGI) postoperatively will significantly increase the rate of missed leaks or lead to worse clinical outcomes.
Methods A retrospective analysis of patients who underwent OPR of GP or DP. Patients were identified by ICD9 billing data. Information was obtained from seven Florida Hospital campuses from 2000 to 2016. A total of 115 (n=115) patients, age 18-85 were identified and divided into two groups: UGI and no UGI. The UGI group was further divided into selective versus routine. A selective UGI was defined as one or more of the following after post operative day 3; WBC > 12, peritonitis, fever > 100.4 F, tachycardia > 100 bpm on three or more assessments, and any UGI performed after POD 7. An excel database was utilized. Symptoms on admission (abdominal pain, tachycardia, chest pain, fever >100.4 F), type of perforation (gastric or duodenal), use of intraoperative leak test, UGI study and leak detection, post operative- nausea, vomiting, fever, tachycardia, peritonitis, leukocytosis, length of stay, mortality, and reoperation within 2 weeks were investigated.
Results 115 patients were included in the study. 29 patients underwent UGI after surgery and 86 did not. There was no significance between the UGI vs non UGI groups relating to preoperative symptoms. There was no difference found in leak detection, death, and reoperation rate between the two groups. The only statistical difference found was length of stay. The median length of stay of the UGI group (N=29) and non-UGI (N=86) was 15.5 days and 8 days, respectively. In our UGI subgroup analysis, 20 of the 29 patients received selective versus routine studies. Between both groups, there was no statistical difference identified in leak detection, death, and reoperation.
Conclusions Use of a postoperative UGI study was not significantly different in regards to leak detection, death and reoperation rate in patients with perforated gastric or duodenal ulcers repaired with an omental patch. However, use of selective and routine UGI increases length of stay. There was no superiority demonstrated between the use of a selective versus routine UGI and the use of selective UGI should be based upon clinical indications
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77376
Program Number: S104
Presentation Session: Acute Care Surgery
Presentation Type: Podium