Outpatient colonoscopy had equivalent safety with hospitals

Digestive Disease Week 2011

CHICAGO — Outpatient colonoscopies performed at ambulatory surgical centers produced a safety profile similar to that of hospitals, according to the results of a retrospective cohort study.

With its lower per-patient cost, roughly $250, and comparable safety profile, outpatient exams performed at ambulatory surgical centers could result in savings for insurers and patients, if other quality indicators are also equal, said M. Fuad Azrak, MD, gastrointestinal fellow at Emory University and a guest researcher at the CDC. Azrak presented the results during Digestive Disease Week 2011.

“We found that the complications of these outpatient colonoscopies were comparable between ambulatory surgical centers and hospitals,” Azrak said. “The implication of our research is that, if these adverse events are equal between both settings, with lower costs per-case associated with outpatient colonoscopy when performed at these ambulatory surgical centers, there might be a cost-saving for Medicare.”

Researchers evaluated a random 5% sample of Medicare beneficiaries who underwent outpatient colonoscopy from 1992 to 2007 and lived in SEER database registry areas (n=174,352). Place of colonoscopy was defined as office, hospital, outpatient or missing/other.

Using Medicare claims, Azrak and colleagues identified patients who visited EDs or were hospitalized with possible gastrointestinal and cardiovascular complications, including bleeding, perforation, angina/myocardial infarction, arrhythmias, pneumonia or death within 30 days of colonoscopy.

On univariate analysis, there were 3.47 hospitalizations or ED visits per 100 patients for those screened in hospitals compared with 2.43 for those screened at ambulatory surgical centers. Patients in the ambulatory surgical center group also had lower rates of perforations (1.2% vs. 0.9%), gastrointestinal bleeding (8.3% vs. 5.2%) and diverticulitis (2.2% vs. 1.2%), and lower incidence of cardiovascular adverse events.

After adjusting for possible confounding variables, the risk of complications was comparable between hospitals and ambulatory surgical centers (OR=1.06). – by Jason Harris

For more information:

Azrak MF. #678. Presented at: Digestive Disease Week 2011; May 7-10, 2011; Chicago.

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