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

• Published in: Gastrointestinal endoscopy Vol. 85; no. 1; pp. 101 - 108
• Main Authors: Vargo, John J., Niklewski, Paul J., Williams, J. Lucas, Martin, James F., Faigel, Douglas O.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2017
• Subjects: Adult; Aged; Anesthesiology - statistics & numerical data; Colonoscopy - statistics & numerical data; Conscious Sedation - adverse effects; Endoscopy, Gastrointestinal - statistics & numerical data; Female; Gastroenterology and Hepatology; Health Status; Humans; Hypnotics and Sedatives - administration & dosage; Hypnotics and Sedatives - adverse effects; Male; Middle Aged; Patient Safety; Retrospective Studies; Risk Factors; ADS; OR; EDS; SAE; CORI; NED; ASA; Clinical Outcomes Research Initiative; American Society of Anesthesiologists; odds ratio; serious adverse event; endoscopist-directed sedation; National Endoscopic Database; anesthesia-directed sedation
• DOI: 10.1016/j.gie.2016.02.007
• ISSN: 0016-5107; 1097-6779

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. 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. 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. 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.