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2016 ; 150
(4
): 888-94; quiz e18
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Risks Associated With Anesthesia Services During Colonoscopy
#MMPMID26709032
Wernli KJ
; Brenner AT
; Rutter CM
; Inadomi JM
Gastroenterology
2016[Apr]; 150
(4
): 888-94; quiz e18
PMID26709032
show ga
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.
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