Substantial Increase in Anesthesia Assistance for Outpatient Colonoscopy and Associated Cost Nationwide

Krigel, Anna; Chen, Ling; Wright, Jason D.; Lebwohl, Benjamin

doi:10.1016/j.cgh.2018.12.037

Cited by 25 publications

(16 citation statements)

References 25 publications

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“…12,14 Besides, fear of sedation was cited as one of the barriers to participate in colonoscopy screening. However, sedation increases the cost and 30-day complications.…”

Section: Discussionmentioning

confidence: 99%

“…However, sedation increases the cost and 30-day complications. 12,14 Besides, fear of sedation was cited as one of the barriers to participate in colonoscopy screening. 28 In Taiwan, colonoscopy was usually performed without sedation or with minimal sedation in the past, while full sedation is rapidly gaining popularity in recent years.…”

Section: Discussionmentioning

confidence: 99%

“…6,7,8 Water exchange (WE), an insertion method characterized by infusing water to guide scope advancement in an airless lumen with nearly complete removal of infused water during the insertion phase, 9 has been reported to reduce insertion pain. 12,13 In addition to the wellrecognized direct cost of sedation, 14 there are some indirect costs that are not as well-recognized, including the time burden of recovery at home (up to 17.7 h in one report), 15 missing work days in addition to the procedure day, 16 and the need for an escort. 5,10,11 The on-demand sedation option has certain advantages over full sedation.…”

Section: Introductionmentioning

confidence: 99%

“…Use of sedation is associated with a small but real risk of cardiopulmonary complications. 12,13 In addition to the wellrecognized direct cost of sedation, 14 there are some indirect costs that are not as well-recognized, including the time burden of recovery at home (up to 17.7 h in one report), 15 missing work days in addition to the procedure day, 16 and the need for an escort. By reducing the need for sedation, on-demand sedation curtails the sedation complications and some of the associated cost.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of sedation on demand in Taiwan using water exchange and air insufflation: A randomized controlled trial

Hsieh

Tseng

Koo

et al. 2019

J of Gastro and Hepatol

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Background and Aim Completion of colonoscopy without sedation eliminates sedation cost and complications. Reported in the United States and Europe, on‐demand sedation is not routine practice in Taiwan. Water exchange (WE), characterized by infusion and nearly complete removal of infused water during insertion, reduces insertion pain compared to air insufflation (AI) during colonoscopy. We evaluated the feasibility of on‐demand sedation in Taiwan. In a randomized controlled trial of WE vs AI colonoscopy, we also aimed to determine if WE augmented the implementation by reducing insertion pain and decreasing sedation requirement. Methods This prospective patient‐blinded study randomized patients to AI or WE (75 patients/group) to aid insertion. The primary outcome was the proportion of patients completing without sedation. Results In the AI and WE groups, 76.0% and 93.3% (P = 0.006) completed without need for sedation, respectively. The WE group had lower insertion pain score (mean [SD]) (4.0 [2.9] vs 2.1 [2.6], P < 0.001), lower doses of propofol (25.7 [52.7] mg vs 9.1 [35.6] mg, P = 0.012), and less time in the recovery room (3.4 [7.4] vs 1.5 [5.5], P = 0.027) than the AI group. Patient satisfaction scores and willingness to repeat if needed in the future were similar. Conclusion On‐demand sedation was feasible in Taiwan. The completion rate without sedation was high in patients (76.0% with standard AI) open to the option (no prior intent to receive the standard of full or minimal sedation). WE augmented the implementation by reducing insertion pain and decreasing sedation requirement without adversely affecting patient satisfaction or willingness to repeat.

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“…12,14 Besides, fear of sedation was cited as one of the barriers to participate in colonoscopy screening. However, sedation increases the cost and 30-day complications.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Feasibility of sedation on demand in Taiwan using water exchange and air insufflation: A randomized controlled trial

Hsieh

Tseng

Koo

et al. 2019

J of Gastro and Hepatol

View full text Add to dashboard Cite

show abstract

“…The study by Krigel et al 11 adds substantively to existing studies by capitalizing on novel features of the Premier Perspectives database, containing data on outpatient hospital-based colonoscopy utilization at facilities that are largely small to medium in size, nonteaching, and urban in location. The unique characteristics of this data set also allowed the investigators to specifically evaluate pharmacy data, rather than rely solely on anesthesia Current Procedural Terminology coding as a surrogate marker for propofol use as has been done in prior studies.…”

mentioning

confidence: 99%

Putting the Horse Back in the Barn: Right-Sizing Use of Anesthesia Assistance for Routine Gastrointestinal Endoscopy

Adams

2019

Clinical Gastroenterology and Hepatology

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Watching Videos of Colonoscopies and Receiving Interpretations Reduce Pain and Anxiety While Increasing the Satisfaction of Patients

et al. 2020

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Substantial Increase in Anesthesia Assistance for Outpatient Colonoscopy and Associated Cost Nationwide

Cited by 25 publications

References 25 publications

Feasibility of sedation on demand in Taiwan using water exchange and air insufflation: A randomized controlled trial

Feasibility of sedation on demand in Taiwan using water exchange and air insufflation: A randomized controlled trial

Putting the Horse Back in the Barn: Right-Sizing Use of Anesthesia Assistance for Routine Gastrointestinal Endoscopy

Watching Videos of Colonoscopies and Receiving Interpretations Reduce Pain and Anxiety While Increasing the Satisfaction of Patients

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