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Anesthesia assistance during colonoscopy may lead to more post-procedure complications
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Patients who received deep sedation anesthesia while undergoing colonoscopy were more likely to experience post-procedure complications, although the risk for complications remained low, in a recent study.
Researchers evaluated 100,359 patients aged 66 years or older who underwent 165,527 colonoscopies without polypectomy, including 35,128 in which deep sedation using propofol, or anesthesia assistance, was administered. The cohort was selected via a random 5% sample of claims submitted for outpatient colonoscopy by cancer-free Medicare beneficiaries enrolled in the linked SEER Program-Medicare database between January 2000 and November 2009. Postoperative complications, including aspiration pneumonia, colonic perforation or splenic rupture/trauma within 30 days of the procedure, were observed and compared between those who received and did not receive deep sedation.
The assessed complications occurred in 284 patients and included 101 perforations, 173 aspirations and 12 splenic traumas or ruptures. Patients who received deep sedation experienced complications more frequently than those who did not, overall (0.22% of cases vs. 0.16%; P<.001) and specifically involving aspirations (0.14% vs. 0.1%; P=.02).
Splenic injury and perforation occurred at similar rates between those who did and did not receive anesthesia. Mortality rates at 30 days (0.32% of those with anesthesia assistance vs. 0.28% without; P=.29) and 1 year (2.82% vs. 2.64%; P=.06) also were similar.
Multivariate analysis indicated an association between anesthesia use and increased risk for complications (OR=1.46; 95% CI, 1.09-1.94). Other associated factors were advanced age, male sex, comorbidities and having the procedure in a hospital vs. an ambulatory setting.
“We identified the use of anesthesiology services for colonoscopy as one of the risk factors for complications, specifically aspiration pneumonia,” the researchers wrote. “The absolute risk for these complications was low in colonoscopies with as well as those without anesthesiologist involvement, and differences may have resulted in part from uncontrolled confounding based on patient severity. Nonetheless, the depth of sedation may serve as an independent risk factor for adverse outcomes.”
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