Complications of Anesthesia Services in Gastrointestinal Endoscopic Procedures
Sarah R Lieber, Benjamin J Heller, Christopher F Martin, Christopher W Howard, Seth Crockett, Sarah R Lieber, Benjamin J Heller, Christopher F Martin, Christopher W Howard, Seth Crockett
Abstract
Background & aims: Despite the increased use of anesthesia services for endoscopic procedures in the United States, the risks of anesthesia-directed sedation (ADS) are unclear. We analyzed national data from multiple centers to determine patterns of use of anesthesia services and risk factors for serious complications.
Methods: We performed a cross-sectional study using the National Anesthesia Clinical Outcomes Registry, a national quality improvement database. Univariable and bivariate analyses investigated frequencies and relationships between predefined variables and serious complications of anesthesia (cardiovascular, respiratory, neurologic, drug-related, patient injury, death, or unexpected admission). A multivariable mixed-effects model determined the odds ratios between these variables and serious complications, adjusting for confounders and varying reporting practices.
Results: In total, 428,947 endoscopic procedures of adults were performed using ADS from 2010 to 2015. The population was 54.9% female with a mean age of 59.1 years, and predominantly American Society of Anesthesiologists classes 2 and 3 (74.4%). More than half of the procedures were colonoscopies (51.4%); 37.4% were esophagogastroduodenoscopies and 6.5% were endoscopic retrograde cholangiopancreatographies. A total of 4441 complications (1.09%) were reported; 1349 were serious complications (0.34%). In multivariable analysis, older age, American Society of Anesthesiologists classes 4 and 5, esophagogastroduodenoscopy, general anesthesia, cases performed on an overnight shift, and longer cases were associated independently and significantly with serious complications.
Conclusions: In an analysis of data from the National Anesthesia Clinical Outcomes Registry, we found ADS during endoscopy to be safe, with few serious complications (<1% of procedures). Risk of ADS complications increased with older age, more severe disease, procedure type, and case complexity.
Keywords: ASA; Colonoscopy; EGD; ERCP.
Conflict of interest statement
Disclosures:
The authors have no conflicts of interest to disclose.
Copyright © 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.
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References
- Inadomi JM, Gunnarsson CL, Rizzo JA, et al. Projected increased growth rate of anesthesia professional–delivered sedation for colonoscopy and EGD in the United States: 2009 to 2015. Gastrointest Endosc 2010;72:580–586.
- Liu H, Waxman DA, Main R, et al. Utilization of Anesthesia Services During Outpatient Endoscopies and Colonoscopies and Associated Spending in 2003–2009. JAMA 2012;307:1178.
- Cohen LB, Wecsler JS, Gaetano JN, et al. Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol 2006;101:967–74.
- Khiani VS, Soulos P, Gancayco J, et al. Anesthesiologist Involvement in Screening Colonoscopy: Temporal Trends and Cost Implications in the Medicare Population. Clin Gastroenterol Hepatol 2012;10:58–64.e1.
- Hirshman S, Mattke S, Liu H. Anesthesia Service Use and the Uptake of Screening Colonoscopies. Med Care 2017;55:623–628.
- Cooper GS, Kou TD, Rex DK. Complications Following Colonoscopy With Anesthesia Assistance. JAMA Intern Med 2013;173:551.
- Bielawska B, Hookey LC, Sutradhar R, et al. Anesthesia Assistance in Outpatient Colonoscopy and Risk of Aspiration Pneumonia, Bowel Perforation, and Splenic Injury. Gastroenterology 2017;0.
- Wernli KJ, Brenner AT, Rutter CM, et al. Risks Associated With Anesthesia Services During Colonoscopy. Gastroenterology 2016;150:888–894.
- Bielawska B, Day AG, Lieberman DA, et al. Risk Factors for Early Colonoscopic Perforation Include Non-Gastroenterologist Endoscopists: A Multivariable Analysis. Clin Gastroenterol Hepatol 2014;12:85–92.
- Vargo JJ, Niklewski PJ, Williams JL, et al. Patient safety during sedation by anesthesia professionals during routine upper endoscopy and colonoscopy: an analysis of 1.38 million procedures. Gastrointest Endosc 2017;85:101–108.
- Wadhwa V, Issa D, Garg S, et al. Similar Risk of Cardiopulmonary Adverse Events Between Propofol and Traditional Anesthesia for Gastrointestinal Endoscopy: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2017;15:194–206.
- Adeyemo A, Bannazadeh M, Riggs T, et al. Does Sedation Type Affect Colonoscopy Perforation Rates? Dis Colon Rectum 2014;57:110–114.
- Leslie K, Allen ML, Hessian EC, et al. Safety of sedation for gastrointestinal endoscopy in a group of university-affiliated hospitals: a prospective cohort study. Br J Anaesth 2017;118:90–99.
- Tillquist MN, Gabriel RA, Dutton RP, et al. Incidence and risk factors for early postoperative reintubations. J Clin Anesth 2016;31:80–89.
- Whitlock EL, Feiner JR, Chen L. Perioperative Mortality, 2010 to 2014. Anesthesiology 2015;123:1312–1321.
- Dominitz JA, Baldwin L– M, Green P, et al. Regional Variation in Anesthesia Assistance During Outpatient Colonoscopy Is Not Associated With Differences in Polyp Detection or Complication Rates. Gastroenterology 2013;144:298–306.
- Fagà E, De Cento M, Giordanino C, et al. Safety of propofol in cirrhotic patients undergoing colonoscopy and endoscopic retrograde cholangiography. Eur J Gastroenterol Hepatol 2012;24:70–76.
- Adams MA, Saleh A, Rubenstein JH. A Systematic Review of Factors Associated With Utilization of Monitored Anesthesia Care for Gastrointestinal Endoscopy. Gastroenterol Hepatol (NY) 2016;12:361–70.
- Dutton RP, Dukatz A. Quality improvement using automated data sources: the anesthesia quality institute. Anesthesiol Clin 2011;29:439–54.
Source: PubMed