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. 2020 Aug;18(9):2118-2127.e4.
doi: 10.1016/j.cgh.2019.10.011. Epub 2019 Oct 14.

Complications of Anesthesia Services in Gastrointestinal Endoscopic Procedures

Sarah R Lieber  1 , Benjamin J Heller  2 , Christopher F Martin  3 , Christopher W Howard  2 , Seth Crockett  3
Affiliations

Complications of Anesthesia Services in Gastrointestinal Endoscopic Procedures

Sarah R Lieber et al. Clin Gastroenterol Hepatol. 2020 Aug.

Abstract

Background & aims: Despite the increased use of anesthesia services for endoscopic procedures in the United States, the risks of anesthesia-directed sedation (ADS) are unclear. We analyzed national data from multiple centers to determine patterns of use of anesthesia services and risk factors for serious complications.

Methods: We performed a cross-sectional study using the National Anesthesia Clinical Outcomes Registry, a national quality improvement database. Univariable and bivariate analyses investigated frequencies and relationships between predefined variables and serious complications of anesthesia (cardiovascular, respiratory, neurologic, drug-related, patient injury, death, or unexpected admission). A multivariable mixed-effects model determined the odds ratios between these variables and serious complications, adjusting for confounders and varying reporting practices.

Results: In total, 428,947 endoscopic procedures of adults were performed using ADS from 2010 to 2015. The population was 54.9% female with a mean age of 59.1 years, and predominantly American Society of Anesthesiologists classes 2 and 3 (74.4%). More than half of the procedures were colonoscopies (51.4%); 37.4% were esophagogastroduodenoscopies and 6.5% were endoscopic retrograde cholangiopancreatographies. A total of 4441 complications (1.09%) were reported; 1349 were serious complications (0.34%). In multivariable analysis, older age, American Society of Anesthesiologists classes 4 and 5, esophagogastroduodenoscopy, general anesthesia, cases performed on an overnight shift, and longer cases were associated independently and significantly with serious complications.

Conclusions: In an analysis of data from the National Anesthesia Clinical Outcomes Registry, we found ADS during endoscopy to be safe, with few serious complications (<1% of procedures). Risk of ADS complications increased with older age, more severe disease, procedure type, and case complexity.

Keywords: ASA; Colonoscopy; EGD; ERCP.

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Conflict of interest statement

Disclosures:

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Flow chart depicting cases in the NACOR database and the study population.
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