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Regional variation in anesthesia assistance during outpatient colonoscopy

A study in the latest Gastroenterology reports on regional variation in anesthesia assistance during outpatient colonoscopy is not associated with differences in polyp detection or complication rates.

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Dr Jason Dominitz and colleagues from Washington, USA investigated the rate and predictors of anesthesia assistance during outpatient colonoscopy and whether anesthesia assistance is associated with colonoscopy interventions and outcomes.

The researchers performed a retrospective cohort study using a 20% sample of Medicare administrative claims submitted during the 2003 calendar year.

The team analyzed data from 328,177 adults, 66 years old or older, who underwent outpatient colonoscopy examinations.

Overall, 9% of outpatient colonoscopies were performed with anesthesia assistance.

The team found that independent predictors of anesthesia assistance included black race, female sex, and a nonscreening indication.

Anesthesia assistance increased with median income and comorbidities.

75% of providers had no colonoscopies with anesthesia assistance recorded in their dataset
Gastroenterology

General and colorectal surgeons, fewer years in their practice, and nonhospital site of service were also significantly associated with anesthesia assistance.

The research team found that the strongest predictor of anesthesia assistance was the Medicare carrier, with odds ratios ranging from 0.22 for the Arkansas carrier to 9.9 for the Empire carrier in New York area compared with the Wisconsin carrier.

There was also considerable variation among endoscopists.

The researchers noted that 75% of providers had no colonoscopies with anesthesia assistance recorded in their dataset, and 5% of providers had anesthesia assistance in at least three quarters of their examinations.

Anesthesia assistance was not associated with the diagnosis of polyps, the performance of biopsy or polypectomy, or complications in multivariate analyses.

Dr Dominitz's team commented, "There are significant variations among regions and sites of service in anesthesia assistance during outpatient colonoscopies of Medicare beneficiaries."

"Although this variation has considerable economic implications, it was not associated with measures of patient risk or outcomes, such as polyp detection or procedure-related complications."

Gastroenterology 2013: 144(2): 298-306
08 February 2013

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