Complications following colonoscopy with anesthesia assistance: a population-based analysis.

IMPORTANCE Deep sedation for endoscopic procedures has become an increasingly used option but, because of impairment in patient response, this technique also has the potential for a greater likelihood of adverse events. The incidence of these complications has not been well studied at a population level. DESIGN Population-based study. SETTING AND PARTICIPANTS Using a 5% random sample of cancer-free Medicare beneficiaries who resided in one of the regions served by a SEER (Surveillance, Epidemiology, and End Results) registry, we identified all procedural claims for outpatient colonoscopy without polypectomy from January 1, 2000, through November 30, 2009. INTERVENTION Colonoscopy without polypectomy, with or without the use of deep sedation (identified by a concurrent claim for anesthesia services). MAIN OUTCOME MEASURES The occurrence of hospitalizations for splenic rupture or trauma, colonic perforation, and aspiration pneumonia within 30 days of the colonoscopy. RESULTS We identified a total of 165 527 procedures in 100 359 patients, including 35 128 procedures with anesthesia services (21.2%). Selected postprocedure complications were documented after 284 procedures (0.17%) and included aspiration (n = 173), perforation (n = 101), and splenic injury (n = 12). (Some patients had >1 complication.) Overall complications were more common in cases with anesthesia assistance (0.22% [95% CI, 0.18%-0.27%]) than in others (0.16% [0.14%-0.18%]) (P < .001), as was aspiration (0.14% [0.11%-0.18%] vs 0.10% [0.08%-0.12%], respectively; P = .02). Frequencies of perforation and splenic injury were statistically similar. Other predictors of complications included age greater than 70 years, increasing comorbidity, and performance of the procedure in a hospital setting. In multivariate analysis, use of anesthesia services was associated with an increased complication risk (odds ratio, 1.46 [95% CI, 1.09-1.94]). CONCLUSIONS AND RELEVANCE Although the absolute risk of complications is low, the use of anesthesia services for colonoscopy is associated with a somewhat higher frequency of complications, specifically, aspiration pneumonia. The differences may result in part from uncontrolled confounding, but they may also reflect the impairment of normal patient responses with the use of deep sedation.

[1]  S Kamen,et al.  The task force. , 1976, Journal of hospital dental practice.

[2]  L. Kessler,et al.  Potential for Cancer Related Health Services Research Using a Linked Medicare‐Tumor Registry Database , 1993, Medical care.

[3]  J. Newhouse,et al.  Econometrics in outcomes research: the use of instrumental variables. , 1998, Annual review of public health.

[4]  C. Klabunde,et al.  Assessing Comorbidity Using Claims Data: An Overview , 2002, Medical care.

[5]  Deborah Schrag,et al.  Overview of the SEER-Medicare Data: Content, Research Applications, and Generalizability to the United States Elderly Population , 2002, Medical care.

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

[7]  Rinku Sutradhar,et al.  Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. , 2008, Gastroenterology.

[8]  B. Levin,et al.  Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. , 2008, Gastroenterology.

[9]  J. Stockman,et al.  Complications of Colonoscopy in an Integrated Health Care Delivery System , 2008 .

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

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

[12]  G. Salen,et al.  Splenic Injury as a Complication of Colonoscopy: A Case Series , 2008, The American Journal of Gastroenterology.

[13]  L. Rabeneck,et al.  A Population-based Analysis of Outpatient Colonoscopy in Adults Assisted by an Anesthesiologist , 2009, Anesthesiology.

[14]  P. Kwo,et al.  Position statement: Nonanesthesiologist administration of propofol for GI endoscopy , 2009, Hepatology.

[15]  D. Ransohoff,et al.  Adverse Events After Outpatient Colonoscopy in the Medicare Population , 2009, Annals of Internal Medicine.

[16]  D. Rex,et al.  Endoscopist-directed administration of propofol: a worldwide safety experience. , 2009, Gastroenterology.

[17]  M. Kimmey,et al.  Serious complications within 30 days of screening and surveillance colonoscopy are uncommon. , 2010, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[18]  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.

[19]  M. Gemma,et al.  Adverse events during monitored anesthesia care for GI endoscopy: an 8-year experience. , 2011, Gastrointestinal endoscopy.

[20]  L. Walter,et al.  Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis. , 2011, Gastrointestinal endoscopy.

[21]  S. Shankar,et al.  Splenic injury after colonoscopy: case report and review of literature. , 2011, The Ochsner journal.

[22]  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.

[23]  D. Rex,et al.  Prospective Description of Coughing, Hemodynamic Changes, and Oxygen Desaturation During Endoscopic Sedation , 2012, Digestive Diseases and Sciences.

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