Complications following colonoscopy with anesthesia assistance

A population-based analysis

Gregory S. Cooper, Tzuyung D. Kou, Douglas Rex

Research output: Contribution to journalArticle

132 Citations (Scopus)

Abstract

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 complicationswere 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.

Original languageEnglish
Pages (from-to)551-556
Number of pages6
JournalJAMA Internal Medicine
Volume173
Issue number7
DOIs
StatePublished - Apr 8 2013

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Colonoscopy
Deep Sedation
Anesthesia
Aspiration Pneumonia
Population
Wounds and Injuries
Odds Ratio
Splenic Rupture
Medicare
Registries
Comorbidity
Epidemiology
Hospitalization
Outpatients
Multivariate Analysis
Outcome Assessment (Health Care)
Incidence
Neoplasms

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Complications following colonoscopy with anesthesia assistance : A population-based analysis. / Cooper, Gregory S.; Kou, Tzuyung D.; Rex, Douglas.

In: JAMA Internal Medicine, Vol. 173, No. 7, 08.04.2013, p. 551-556.

Research output: Contribution to journalArticle

Cooper, Gregory S. ; Kou, Tzuyung D. ; Rex, Douglas. / Complications following colonoscopy with anesthesia assistance : A population-based analysis. In: JAMA Internal Medicine. 2013 ; Vol. 173, No. 7. pp. 551-556.
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abstract = "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 complicationswere 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.",
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