Risks Associated With Anesthesia Services During Colonoscopy.

BACKGROUND & AIMS We aimed to quantify the difference in complications from colonoscopy with vs without anesthesia services. METHODS We conducted a prospective cohort study and analyzed administrative claims data from Truven Health Analytics MarketScan Research Databases from 2008 through 2011. We identified 3,168,228 colonoscopy procedures in men and women, aged 40-64 years old. Colonoscopy complications were measured within 30 days, including colonic (ie, perforation, hemorrhage, abdominal pain), anesthesia-associated (ie, pneumonia, infection, complications secondary to anesthesia), and cardiopulmonary outcomes (ie, hypotension, myocardial infarction, stroke), adjusted for age, sex, polypectomy status, Charlson comorbidity score, region, and calendar year. RESULTS Nationwide, 34.4% of colonoscopies were conducted with anesthesia services. Rates of use varied significantly by region (53% in the Northeast vs 8% in the West; P < .0001). Use of anesthesia service was associated with a 13% increase in the risk of any complication within 30 days (95% confidence interval [CI], 1.12-1.14), and was associated specifically with an increased risk of perforation (odds ratio [OR], 1.07; 95% CI, 1.00-1.15), hemorrhage (OR, 1.28; 95% CI, 1.27-1.30), abdominal pain (OR, 1.07; 95% CI, 1.05-1.08), complications secondary to anesthesia (OR, 1.15; 95% CI, 1.05-1.28), and stroke (OR, 1.04; 95% CI, 1.00-1.08). For most outcomes, there were no differences in risk with anesthesia services by polypectomy status. However, the risk of perforation associated with anesthesia services was increased only in patients with a polypectomy (OR, 1.26; 95% CI, 1.09-1.52). In the Northeast, use of anesthesia services was associated with a 12% increase in risk of any complication; among colonoscopies performed in the West, use of anesthesia services was associated with a 60% increase in risk. CONCLUSIONS The overall risk of complications after colonoscopy increases when individuals receive anesthesia services. The widespread adoption of anesthesia services with colonoscopy should be considered within the context of all potential risks.

[1]  Tina Fan,et al.  Screening for Colorectal Cancer. , 2021, American family physician.

[2]  Tzuyung D Kou,et al.  Complications following colonoscopy with anesthesia assistance: a population-based analysis. , 2013, JAMA internal medicine.

[3]  J. Inadomi,et al.  Anesthesia for colonoscopy: too much of a good thing? , 2013, JAMA internal medicine.

[4]  W. Kreuter,et al.  Regional variation in anesthesia assistance during outpatient colonoscopy is not associated with differences in polyp detection or complication rates. , 2013, Gastroenterology.

[5]  D. Joseph,et al.  Prevalence of colorectal cancer screening among adults--Behavioral Risk Factor Surveillance System, United States, 2010. , 2012, MMWR supplements.

[6]  S. Mattke,et al.  Utilization of anesthesia services during outpatient endoscopies and colonoscopies and associated spending in 2003-2009. , 2012, JAMA.

[7]  D. Miglioretti,et al.  Adverse events after screening and follow-up colonoscopy , 2012, Cancer Causes & Control.

[8]  Hai Fang,et al.  Projected increased growth rate of anesthesia professional-delivered sedation for colonoscopy and EGD in the United States: 2009 to 2015. , 2010, Gastrointestinal endoscopy.

[9]  D. Rex,et al.  Position statement: Nonanesthesiologist administration of propofol for GI endoscopy. , 2009, Gastroenterology.

[10]  Bernadette Mazurek Melnyk,et al.  Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. , 2008, Annals of internal medicine.

[11]  S. Taback,et al.  Propofol for sedation during colonoscopy. , 2008, The Cochrane database of systematic reviews.

[12]  J. Schulman,et al.  Complications of Colonoscopy in an Integrated Health Care Delivery System , 2006, Annals of Internal Medicine.

[13]  James Aisenberg,et al.  Endoscopic Sedation in the United States: Results from a Nationwide Survey , 2006, The American Journal of Gastroenterology.

[14]  L. Seeff,et al.  How many endoscopies are performed for colorectal cancer screening? Results from CDC's survey of endoscopic capacity. , 2004, Gastroenterology.

[15]  J L Warren,et al.  Development of a comorbidity index using physician claims data. , 2000, Journal of clinical epidemiology.

[16]  C. Gross,et al.  Anesthesiologist involvement in screening colonoscopy: temporal trends and cost implications in the medicare population. , 2012, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.