Complications of Anesthesia Services in Gastrointestinal Endoscopic Procedures.
ASA
Colonoscopy
EGD
ERCP
Journal
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
ISSN: 1542-7714
Titre abrégé: Clin Gastroenterol Hepatol
Pays: United States
ID NLM: 101160775
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
02
08
2019
revised:
27
09
2019
accepted:
04
10
2019
pubmed:
18
10
2019
medline:
19
8
2021
entrez:
18
10
2019
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 31622738
pii: S1542-3565(19)31110-3
doi: 10.1016/j.cgh.2019.10.011
pmc: PMC10692495
mid: NIHMS1545495
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
2118-2127.e4Subventions
Organisme : NCATS NIH HHS
ID : KL2 TR001109
Pays : United States
Organisme : NIDDK NIH HHS
ID : T32 DK007634
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.
Références
Gastrointest Endosc. 2017 Jan;85(1):101-108
pubmed: 26905938
Anesthesiology. 2015 Dec;123(6):1312-21
pubmed: 26492481
Anesthesiol Clin. 2011 Sep;29(3):439-54
pubmed: 21871404
Med Care. 2017 Jun;55(6):623-628
pubmed: 28002204
Clin Gastroenterol Hepatol. 2012 Jan;10(1):58-64.e1
pubmed: 21782768
JAMA Intern Med. 2013 Apr 8;173(7):551-6
pubmed: 23478904
Gastroenterol Hepatol (N Y). 2016 Jun;12(6):361-70
pubmed: 27493596
J Clin Anesth. 2016 Jun;31:80-9
pubmed: 27185683
Gastroenterology. 2018 Jan;154(1):77-85.e3
pubmed: 28865733
Gastroenterology. 2016 Apr;150(4):888-94; quiz e18
pubmed: 26709032
Clin Gastroenterol Hepatol. 2017 Feb;15(2):194-206
pubmed: 27451091
JAMA. 2012 Mar 21;307(11):1178-84
pubmed: 22436958
Gastroenterology. 2013 Feb;144(2):298-306
pubmed: 23103615
Br J Anaesth. 2017 Jan;118(1):90-99
pubmed: 28039246
Eur J Gastroenterol Hepatol. 2012 Jan;24(1):70-6
pubmed: 21941187
Gastrointest Endosc. 2010 Sep;72(3):580-6
pubmed: 20630511
Clin Gastroenterol Hepatol. 2014 Jan;12(1):85-92
pubmed: 23891916
Am J Gastroenterol. 2006 May;101(5):967-74
pubmed: 16573781
Dis Colon Rectum. 2014 Jan;57(1):110-4
pubmed: 24316954