Background & Aims

The increase in use of anesthesia assistance (AA) to achieve deep sedation with propofol during colonoscopy has significantly increased colonoscopy costs without evidence for increased quality and with possible harm. We investigated the effects of AA on colonoscopy complications, specifically bowel perforation, aspiration pneumonia, and splenic injury.

Methods

In a population-based cohort study using administrative databases, we 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. Using a matched propensity score approach, we matched persons who had colonoscopy with AA (1:1) with those who did not. We used logistic regression models under a generalized estimating equations approach to explore the relationship between AA and outcomes.

Results

Data from 3,059,045 outpatient colonoscopies were analyzed; 862,817 of these included AA. After propensity matching, a cohort of 793,073 patients who had AA and 793,073 without AA was retained for analysis (51% female; 78% were age 50 years or older). Use of AA did not significantly increase risk of perforation (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.84–1.16) or splenic injury (OR, 1.09; 95% CI, 0.62–1.90]. Use of AA was associated with an increased risk of aspiration pneumonia (OR, 1.63; 95% CI, 1.11–2.37).

Conclusions

In a population-based cohort study, AA for outpatient colonoscopy was associated with a significantly increased risk of aspiration pneumonia, but not bowel perforation or splenic injury. Endoscopists should warn patients, especially those with respiratory compromise, of this risk.

中文翻译：

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门诊结肠镜检查中的麻醉协助以及吸入性肺炎，肠穿孔和脾损伤的风险

背景与目标

在结肠镜检查期间使用麻醉辅助剂（AA）来实现异丙酚深层镇静的使用的增加，显着增加了结肠镜检查的成本，而没有证据表明质量提高并且可能造成伤害。我们调查了AA对结肠镜检查并发症的影响，特别是肠穿孔，吸入性肺炎和脾损伤。

方法

在使用行政数据库进行的基于人群的队列研究中，我们研究了加拿大安大略省从2005年至2012年接受门诊结肠镜检查的成年人。得出了患者，内镜医师，机构和手术因素。主要结局是使用经验证的算法定义的肠穿孔。次要结果是脾损伤和吸入性肺炎。使用匹配的倾向评分方法，我们将结肠镜检查与AA（1：1）的人与未进行结肠镜检查的人进行了匹配。我们在广义估计方程方法下使用逻辑回归模型来探索AA和结果之间的关系。

结果

分析了3,059,045例门诊结肠镜检查的数据；其中862,817包括AA。倾向匹配后，保留了一组793,073名患有AA和793,073名没有AA的患者进行分析（女性为51％；年龄在50岁或以上的为78％）。使用AA并没有显着增加发生穿孔的风险（几率[OR]为0.99； 95％置信区间[CI]为0.84–1.16）或脾损伤（OR为1.09； 95％CI为0.62-1.90）。 AA与吸入性肺炎的风险增加相关（OR，1.63； 95％CI，1.11-2.37）。

结论

在一项基于人群的队列研究中，门诊结肠镜检查的AA与吸入性肺炎的风险显着增加相关，但与肠穿​​孔或脾损伤无关。内镜医师应警告患者，尤其是呼吸功能不佳的患者这种风险。