Risks Associated With Anesthesia Services During Colonoscopy

Abstract

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.

Providing Deep Sedation for Advanced Endoscopic Procedures: The Esthetics of Endoscopic Anesthetics

“…Although the safety of propofol in endoscopic sedation has been questioned repeatedly, it continues to be a popular anesthetic [5]. One of the major drawbacks of propofol for endoscopic sedation is its enormous pharmacologic variability, calculated at 300-400 % [10], which, when further amplified by the use of opioid adjuvants, is thought responsible for unpredictable sedation depth, especially in the elderly.…”

“…A more recent study concluded that propofol sedation is associated with a 13 % increase in all complications in patients undergoing colonoscopy. Providing sedation for GI endoscopy is thus an area with many undisputed challenges, controversies, and even some conspiracy theories [5,6].…”

Jatrogeninė kolonoskopinė storosios žarnos perforacija: vieno centro chirurginio gydymo rezultatai

“…Wernli et al determined that use of anaesthesia service was associated with a 13% increase in the risk of any complication within 30 days and was associated specifically with an increased risk of colonic perforation. However researchers observed the increased risk for perforation only among patients with polypectomy [12]. It can be explained by the absence of patient feedback, as a result increased colonic-wall tension from colonoscopy pressure may not be identified by the endoscopist.…”

Patient safety under deep sedation for digestive endoscopic procedures

“…Most studies referred to with a large number of patients are retrospective, with patients selected from databases designed for a different purpose (8,12,14,19). The retrospective study by Wernli et al (19) discussed data from medical claims regarding over three million colonoscopies.…”

“…The technique's safety when administered by non-anesthesiologists has traditionally raised controversy, usually disguised as scientificism when the real issue is mainly financial in nature, often covered up by dubious debates on the financial sustainability of the health system (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”