Patient safety during sedation by anesthesia professionals during routine upper endoscopy and colonoscopy: An analysis of 1.38 million procedures

John J. Vargo, Paul J. Niklewski, J. Lucas Williams, James F. Martin, Douglas Orrick Faigel

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Background and Aims: Sedation for GI endoscopy directed by anesthesia professionals (ADS) is used with the intention of improving throughput and patient satisfaction. However, data on its safety are sparse because of the lack of adequately powered, randomized controlled trials comparing it with endoscopist-directed sedation (EDS). This study was intended to determine whether ADS provides a safety advantage when compared with EDS for EGD and colonoscopy. Methods: This retrospective, nonrandomized, observational cohort study used the Clinical Outcomes Research Initiative National Endoscopic Database, a network of 84 sites in the United States composed of academic, community, health maintenance organization, military, and Veterans Affairs practices. Serious adverse events (SAEs) were defined as any event requiring administration of cardiopulmonary resuscitation, hospital or emergency department admission, administration of rescue/reversal medication, emergency surgery, procedure termination because of an adverse event, intraprocedural adverse events requiring intervention, or blood transfusion. Results: There were 1,388,235 patients in this study that included 880,182 colonoscopy procedures (21% ADS) and 508,053 EGD procedures (23% ADS) between 2002 and 2013. When compared with EDS, the propensity-adjusted SAE risk for patients receiving ADS was similar for colonoscopy (OR, .93; 95% CI, .82-1.06) but higher for EGD (OR, 1.33; 95% CI, 1.18-1.50). Additionally, with further stratification by American Society of Anesthesiologists (ASA) class, the use of ADS was associated with a higher SAE risk for ASA I/II and ASA III subjects undergoing EGD and showed no difference for either group undergoing colonoscopy. The sample size was not sufficient to make a conclusion regarding ASA IV/V patients. Conclusions: Within the confines of the SAE definitions used, use of anesthesia professionals does not appear to bring a safety benefit to patients receiving colonoscopy and is associated with an increased SAE risk for ASA I, II, and III patients undergoing EGD.

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
DOIs
StateAccepted/In press - Aug 30 2015

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Colonoscopy
Patient Safety
Endoscopy
Anesthesia
Safety
Health Maintenance Organizations
Hospital Departments
Cardiopulmonary Resuscitation
Veterans
Patient Satisfaction
Blood Transfusion
Sample Size
Observational Studies
Hospital Emergency Service
Emergencies
Cohort Studies
Randomized Controlled Trials
Outcome Assessment (Health Care)
Databases
Anesthesiologists

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

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Patient safety during sedation by anesthesia professionals during routine upper endoscopy and colonoscopy : An analysis of 1.38 million procedures. / Vargo, John J.; Niklewski, Paul J.; Williams, J. Lucas; Martin, James F.; Faigel, Douglas Orrick.

In: Gastrointestinal Endoscopy, 30.08.2015.

Research output: Contribution to journalArticle

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abstract = "Background and Aims: Sedation for GI endoscopy directed by anesthesia professionals (ADS) is used with the intention of improving throughput and patient satisfaction. However, data on its safety are sparse because of the lack of adequately powered, randomized controlled trials comparing it with endoscopist-directed sedation (EDS). This study was intended to determine whether ADS provides a safety advantage when compared with EDS for EGD and colonoscopy. Methods: This retrospective, nonrandomized, observational cohort study used the Clinical Outcomes Research Initiative National Endoscopic Database, a network of 84 sites in the United States composed of academic, community, health maintenance organization, military, and Veterans Affairs practices. Serious adverse events (SAEs) were defined as any event requiring administration of cardiopulmonary resuscitation, hospital or emergency department admission, administration of rescue/reversal medication, emergency surgery, procedure termination because of an adverse event, intraprocedural adverse events requiring intervention, or blood transfusion. Results: There were 1,388,235 patients in this study that included 880,182 colonoscopy procedures (21{\%} ADS) and 508,053 EGD procedures (23{\%} ADS) between 2002 and 2013. When compared with EDS, the propensity-adjusted SAE risk for patients receiving ADS was similar for colonoscopy (OR, .93; 95{\%} CI, .82-1.06) but higher for EGD (OR, 1.33; 95{\%} CI, 1.18-1.50). Additionally, with further stratification by American Society of Anesthesiologists (ASA) class, the use of ADS was associated with a higher SAE risk for ASA I/II and ASA III subjects undergoing EGD and showed no difference for either group undergoing colonoscopy. The sample size was not sufficient to make a conclusion regarding ASA IV/V patients. Conclusions: Within the confines of the SAE definitions used, use of anesthesia professionals does not appear to bring a safety benefit to patients receiving colonoscopy and is associated with an increased SAE risk for ASA I, II, and III patients undergoing EGD.",
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