The increase in use of anesthesia assistance to achieve deep sedation with propofol during colonoscopy has significantly increased colonoscopy costs without evidence for increased quality and with possible harm.
Dr Jill Tinmouth and colleagues from Canada investigated the effects of anesthesia assistance on colonoscopy complications, specifically bowel perforation, aspiration pneumonia, and splenic injury.
In a population-based cohort study using administrative databases, the research team studied adults in Ontario, Canada undergoing outpatient colonoscopy from 2005 through 2012.
Patient, endoscopist, institution, and procedure factors were derived.
The primary outcome was bowel perforation, defined using a validated algorithm.
Secondary outcomes were splenic injury and aspiration pneumonia.
|Use of anesthesia assistance did not significantly increase risk of perforation |
Using a matched propensity score approach, the doctors matched persons who had colonoscopy with anesthesia assistance with those who did not.
The team used logistic regression models under a generalized estimating equations approach to explore the relationship between anesthesia assistance and outcomes.
Data from 3,059,045 outpatient colonoscopies were analyzed; 862,817 of these included anesthesia assistance.
After propensity matching, a cohort of 793,073 patients who had anesthesia assistance and 793,073 without anesthesia assistance was retained for analysis.
Use of anesthesia assistance did not significantly increase risk of perforation or splenic injury .
Use of anesthesia assistance was associated with an increased risk of aspiration pneumonia.
In a population-based cohort study, anesthesia assistance for outpatient colonoscopy was associated with a significantly increased risk of aspiration pneumonia, but not bowel perforation or splenic injury.
Dr Tinmouth's team conculdes that: "Endoscopists should warn patients, especially those with respiratory compromise, of this risk."