Complications Associated With Anesthesia Services in Endoscopic Procedures Among Patients With Cirrhosis.
Adolescent
Adult
Aged
Aged, 80 and over
Anesthesia
/ adverse effects
Cross-Sectional Studies
End Stage Liver Disease
/ complications
Endoscopy
/ adverse effects
Female
Humans
Liver Cirrhosis
/ complications
Male
Middle Aged
Pain, Procedural
/ etiology
Postoperative Complications
/ epidemiology
Prevalence
Registries
/ statistics & numerical data
Severity of Illness Index
United States
/ epidemiology
Young Adult
Journal
Hepatology (Baltimore, Md.)
ISSN: 1527-3350
Titre abrégé: Hepatology
Pays: United States
ID NLM: 8302946
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
15
11
2019
revised:
10
02
2020
accepted:
05
03
2020
pubmed:
11
3
2020
medline:
5
5
2021
entrez:
11
3
2020
Statut:
ppublish
Résumé
Anesthesia services for endoscopic procedures have proliferated with the promise of increased comfort and safety. Cirrhosis patients are higher risk for sedation, yet limited data are available describing anesthesia complications in this population. This cross-sectional study utilized the National Anesthesia Clinical Outcomes Registry, a multicenter quality-improvement database from 2010 to 2015. Patients with cirrhosis undergoing an endoscopy were identified by International Classification of Diseases, Ninth Revision (ICD-9)/Current Procedures Terminology (CPT) codes. The outcome of interest was serious anesthesia-related complication defined as cardiovascular, respiratory, neurological, drug related, patient injury, death, or unexpected admission. A mixed-effects multivariate logistic regression model determined odds ratios (ORs) between variables and serious complications, adjusting for potential confounders. In total, 9,007 endoscopic procedures were performed among patients with cirrhosis; 92% were esophagogastroduodenoscopies. The majority (81%) were American Society of Anesthesiologists (ASA) class ≥3, and 72% had a history of hepatic encephalopathy, ascites, varices, hepatorenal syndrome, or spontaneous bacterial peritonitis identified by ICD-9/CPT codes. In total, 87 complications were reported, 33 of which were serious. Frequency of serious complications was 0.4% or 378.6 per 100,000 procedures (95% confidence interval [CI], 260.8, 531.3). The majority of serious complications were cardiovascular (21 of 33), including 15 cardiac arrests. Serious complications were significantly associated with ASA 4/5 (OR, 3.84; 95% CI, 1.09, 13.57) and general anesthesia (OR, 4.71; 95% CI, 1.20, 18.50), adjusting for age, sex, ASA class, anesthesia type, inpatient status, portal hypertension history, and variable complication reporting practices. Anesthesia complications among endoscopic procedures in cirrhosis are rare overall. Serious complications were predominantly cardiac and associated with sicker patients undergoing general anesthesia. The complexity of end-stage liver disease may warrant more intensive care during endoscopic procedures, including anesthesia monitoring.
Sections du résumé
BACKGROUND AND AIMS
Anesthesia services for endoscopic procedures have proliferated with the promise of increased comfort and safety. Cirrhosis patients are higher risk for sedation, yet limited data are available describing anesthesia complications in this population.
APPROACH AND RESULTS
This cross-sectional study utilized the National Anesthesia Clinical Outcomes Registry, a multicenter quality-improvement database from 2010 to 2015. Patients with cirrhosis undergoing an endoscopy were identified by International Classification of Diseases, Ninth Revision (ICD-9)/Current Procedures Terminology (CPT) codes. The outcome of interest was serious anesthesia-related complication defined as cardiovascular, respiratory, neurological, drug related, patient injury, death, or unexpected admission. A mixed-effects multivariate logistic regression model determined odds ratios (ORs) between variables and serious complications, adjusting for potential confounders. In total, 9,007 endoscopic procedures were performed among patients with cirrhosis; 92% were esophagogastroduodenoscopies. The majority (81%) were American Society of Anesthesiologists (ASA) class ≥3, and 72% had a history of hepatic encephalopathy, ascites, varices, hepatorenal syndrome, or spontaneous bacterial peritonitis identified by ICD-9/CPT codes. In total, 87 complications were reported, 33 of which were serious. Frequency of serious complications was 0.4% or 378.6 per 100,000 procedures (95% confidence interval [CI], 260.8, 531.3). The majority of serious complications were cardiovascular (21 of 33), including 15 cardiac arrests. Serious complications were significantly associated with ASA 4/5 (OR, 3.84; 95% CI, 1.09, 13.57) and general anesthesia (OR, 4.71; 95% CI, 1.20, 18.50), adjusting for age, sex, ASA class, anesthesia type, inpatient status, portal hypertension history, and variable complication reporting practices.
CONCLUSIONS
Anesthesia complications among endoscopic procedures in cirrhosis are rare overall. Serious complications were predominantly cardiac and associated with sicker patients undergoing general anesthesia. The complexity of end-stage liver disease may warrant more intensive care during endoscopic procedures, including anesthesia monitoring.
Identifiants
pubmed: 32153048
doi: 10.1002/hep.31224
pmc: PMC7483314
mid: NIHMS1576813
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
2109-2118Subventions
Organisme : NIDDK NIH HHS
ID : T32DK007634
Pays : United States
Organisme : NIH HHS
ID : KL2-TR001109
Pays : United States
Organisme : NIDDK NIH HHS
ID : T32 DK007634
Pays : United States
Organisme : NIDDK NIH HHS
ID : P30 DK0349
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2 TR001109
Pays : United States
Organisme : NIDDK NIH HHS
ID : P30 DK034987
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2020 by the American Association for the Study of Liver Diseases.
Références
Gastrointest Endosc. 2017 Jan;85(1):101-108
pubmed: 26905938
J Med Syst. 2018 Mar 2;42(4):66
pubmed: 29497856
Korean J Intern Med. 2014 Jan;29(1):57-65
pubmed: 24574834
Anesthesiol Clin. 2011 Sep;29(3):439-54
pubmed: 21871404
Gastroenterology. 2012 Jul;143(1):70-7
pubmed: 22465432
Atherosclerosis. 2014 Jan;232(1):99-109
pubmed: 24401223
Fukushima J Med Sci. 2018 Dec 8;64(3):133-141
pubmed: 30344206
Dig Dis Sci. 2019 Jun;64(6):1460-1469
pubmed: 30673984
JGH Open. 2018 Oct 23;3(1):25-31
pubmed: 30834337
Gastrointest Endosc. 2011 Jan;73(1):45-51, 51.e1
pubmed: 21184869
PLoS One. 2015 Feb 03;10(2):e0117585
pubmed: 25646815
J Clin Anesth. 2016 Jun;31:80-9
pubmed: 27185683
Clin Gastroenterol Hepatol. 2020 Aug;18(9):2118-2127.e4
pubmed: 31622738
Gastroenterology. 2018 Jan;154(1):77-85.e3
pubmed: 28865733
Hepatology. 2018 Dec;68(6):2230-2238
pubmed: 29774589
Gastroenterology. 2016 Apr;150(4):888-94; quiz e18
pubmed: 26709032
Clin Gastroenterol Hepatol. 2017 Feb;15(2):194-206
pubmed: 27451091
Gut. 2008 Feb;57(2):268-78
pubmed: 18192456
JAMA. 2012 Mar 21;307(11):1178-84
pubmed: 22436958
Hepatology. 2017 Jan;65(1):310-335
pubmed: 27786365
Eur J Gastroenterol Hepatol. 2012 Jan;24(1):70-6
pubmed: 21941187
Clin Gastroenterol Hepatol. 2018 Oct;16(10):1677-1678
pubmed: 29410051
Gastrointest Endosc. 2010 Sep;72(3):580-6
pubmed: 20630511
Clin Gastroenterol Hepatol. 2014 Jan;12(1):85-92
pubmed: 23891916
Dig Dis Sci. 2016 Mar;61(3):825-34
pubmed: 26541992
JAMA Intern Med. 2013 Apr 8;173(7):551-6
pubmed: 23478904
Aliment Pharmacol Ther. 2008 Feb 1;27(3):274-82
pubmed: 17996017
J Clin Gastroenterol. 2013 May-Jun;47(5):e50-4
pubmed: 23090041
Am J Gastroenterol. 2006 May;101(5):967-74
pubmed: 16573781
Dis Colon Rectum. 2014 Jan;57(1):110-4
pubmed: 24316954
J Viral Hepat. 2018 Nov;25(11):1270-1279
pubmed: 29851265