P1.043: Does Variation in Imaging Workup for Patients Undergoing Elective Repair of Pectus Excavatum Affect Clinically Relevant Outcomes?

Background: Variation in care is a driver of low value care through poor quality, inequitable care and wasted cost. We previously hypothesized that there is variation in the preoperative evaluation of children undergoing minimally invasive repair of pectus excavatum (MIRPE), evaluated this variation, and found that most variation occurred in the amount and type of preoperative work-up patients received prior to surgery. This subsequent work aims to evaluate if the variation in preoperative imaging affects clinically relevant parameters such as the severity of Haller index, amount of time between clinic visit and MIRPE, or the postoperative length-of-stay (LOS) for patients undergoing MIRPE.

Methods: A single-center retrospective review analyzed 52 MIRPE patients between July 2021 and October 2023. The number of total preoperative studies including electrocardiogram (EKG), echocardiogram (Echo), pulmonary function testing (PFT), exercise stress test (EST), chest x-ray (CXR), computed tomography of the chest (CT), magnetic resonance imaging of the chest (MRI) were calculated for each patient. Linear regression was performed to assess the effect of the number of preoperative studies patients received on the severity of Haller index, time between clinic visit and MIRPE and postoperative LOS. An alpha of 0.05 was considered statistically significant.

Results: Patients undergoing elective repair of pectus excavatum had a median of one preoperative imaging study (IQR 1, 3). Eight patients had 4 or more preoperative studies (15.3%). Most patients had a CT (n=42, 80.8%), followed by Echo (n=22, 42.3%). The median Haller index was 4.5 (IQR 3.6, 5.0). Time between clinic visit and MIRPE ranged from 40 days to 1300 days with patients waiting a median of 147 days for MIRPE after meeting with the surgeon (IQR 107, 257). After MIRPE, patients stayed a median of three days in the hospital (IQR 2, 3) and a maximum of 5 days before returning home. The number of preoperative studies obtained did not predict the severity of the Haller index (coeff=0.133, p=0.26), lengthen or shorten the time between clinic visit and MIRPE (coeff=-0.001, p=0.20), or predict longer or shorter postoperative LOS (coeff=-0.03, p=0.89) (Table).

Conclusion: Variation in the number of preoperative studies patients received before elective repair of pectus excavatum was not associated with the severity of their defect, the time to surgery after clinic visit or the length of hospital recovery patients required postoperatively. We previously reported increased cost associated with more preoperative imaging, particularly the use of CT or MRI, and now describe no concurrent effect on clinically relevant patient outcomes. Our results suggest that variation in the amount of preoperative work-up may not affect outcomes that matter for patients, presenting an opportunity for reducing this variation to further high-value care for patients undergoing MIRPE.