Risk Factors for Early Colonoscopic Perforation Include Non-Gastroenterologist Endoscopists: A Multivariable Analysis

• Published in: Clinical gastroenterology and hepatology Vol. 12; no. 1; pp. 85 - 92
• Main Authors: Bielawska, Barbara, Day, Andrew G, Lieberman, David A, Hookey, Lawrence C
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2014
• Subjects: Adult; Aged; Aged, 80 and over; ASA Classification; Colonoscopy - adverse effects; Endoscopy Training; Female; Gastroenterology and Hepatology; Humans; Intestinal Perforation - epidemiology; Intestine; Male; Middle Aged; Multivariate Analysis; Professional Competence; Quality Control; Retrospective Studies; Risk Factors; health maintenance organization; GI; OR; CI; Clinical Outcomes Research Initiative; IBD; HMO; odds ratio; VA; inflammatory bowel disease; ASA; ASA Classification; Intestine; Veterans Affairs; American Society of Anesthesia; confidence interval; Endoscopy Training; CORI; Quality Control
• ISSN: 1542-3565; 1542-7714
• DOI: 10.1016/j.cgh.2013.06.030

Background & Aims Bowel perforation is a rare but serious complication of colonoscopy. Its prevalence is increasing with the rapidly growing volume of procedures performed. Although colonoscopies have been performed for decades, the risk factors for perforation are not completely understood. We investigated risk factors for perforation during colonoscopy by assessing variables that included sedation type and endoscopist specialty and level of training. Methods We performed a retrospective multivariate analysis of risk factors for early perforation (occurring at any point during the colonoscopy but recognized during or immediately after the procedure) in adult patients by using the Clinical Outcomes Research Initiative National Endoscopic Database. Risk factors were determined from published articles. Additional variables assessed included endoscopist specialty and years of experience, trainee involvement, and sedation with propofol. Results We identified 192 perforation events during 1,144,900 colonoscopies from 85 centers entered into the database from January 2000–March 2011. On multivariate analysis, increasing age, American Society of Anesthesia class, female sex, hospital setting, any therapy, and polyps >10 mm were significantly associated with increased risk of early perforation. Colonoscopies performed by surgeons and endoscopists of unknown specialty had higher rates of perforation than those performed by gastroenterologists (odds ratio, 2.00; 95% confidence interval, 1.30–3.08). Propofol sedation did not significantly affect risk for perforation. Conclusions In addition to previously established risk factors, non-gastroenterologist specialty was found to affect risk for perforations detected during or immediately after colonoscopy. This finding could result from differences in volume and style of endoscopy training. Further investigation into these observed associations is warranted.