BACKGROUND The age to stop screening or surveillance colonoscopy is not well established, and unplanned hospital use after colonoscopy in the elderly is not well understood. AIMS To evaluate unplanned emergency department (ED) visits and hospitalization in patients over 75 within 7 days of outpatient colonoscopy. METHODS In this retrospective, single-center, cohort study, we reviewed outpatient screening or surveillance colonoscopies in patients ≥ 50 in a tertiary care academic medical center or affiliated facility between January 2008 and September 2013. Colonoscopies were divided by age based on USPSTF recommendations. The rate of ED visits and hospitalizations per colonoscopy for each age-group was determined. Predictors of ED visit and hospitalization were assessed through univariate and multivariate logistic regressions, and mortality following colonoscopy was evaluated using Kaplan-Meier analysis. RESULTS A total of 30,409 colonoscopies were performed in 27,173 patients (51% male) by 40 endoscopists. ED visits occurred after 188 colonoscopies (0.62%). Age over 75 years was independently associated with ED visit (OR 1.58, 95% CI 1.05-2.37, p = 0.027) and hospitalization (OR 3.7, 95% CI 2.03-6.73, p < 0.001) within 7 days of colonoscopy. Higher number of medication classes, recent ED visit, polypectomy, and endoscopic mucosal resection were also independent variables associated with ED utilization after procedure. The mortality rate at the end of the follow-up (median 4.4; IQR 2.7-6 years) was 1.9, 8.6, and 15.8% for the age-groups 50-75, 76-85, and > 85 years, respectively. CONCLUSION Patients over age 75 are 1.6 times as likely to use the ED and 3.7 times as likely to be hospitalized after colonoscopy. Further prospective studies are needed to assess the risk/benefit of nondiagnostic colonoscopy in geriatric patients.

中文翻译：

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75岁以上的患者在结肠镜检查后急诊就诊和住院的风险增加。

背景技术停止筛查或监测结肠镜检查的年龄尚不明确，并且对老年人结肠镜检查后计划外的医院使用尚不甚了解。目的评估门诊结肠镜检查7天内75岁以上患者的计划外急诊就诊和住院情况。方法在这项回顾性，单中心，队列研究中，我们回顾了2008年1月至2013年9月在三级医疗学术医学中心或附属机构中对≥50岁的患者进行门诊筛查或监测结肠镜检查。根据USPSTF的建议，按年龄对结肠镜检查进行了划分。确定了每个年龄组的急诊就诊率和每次结肠镜检查的住院率。ED访视和住院的预测因素通过单因素和多因素logistic回归进行评估，使用Kaplan-Meier分析评估结肠镜检查后的死亡率。结果40位内镜医师对27,173例患者（51％男性）进行了30,409例结肠镜检查。188例结肠镜检查（0.62％）后进行急诊就诊。结肠镜检查7天内，超过75岁的年龄与ED访视（OR 1.58，95％CI 1.05-2.37，p = 0.027）和住院（OR 3.7，95％CI 2.03-6.73，p <0.001）独立相关。较高的药物种类，近期的ED就诊，息肉切除术和内镜下黏膜切除术也是与手术后ED利用率相关的独立变量。在50-75岁，76-85岁和> 85岁年龄组中，随访结束时的死亡率（中位数4.4； IQR 2.7-6岁）分别为1.9、8.6和15.8％。结论75岁以上的患者使用ED的可能性是其1.6倍，是3倍。结肠镜检查后住院的可能性是原来的7倍。需要进一步的前瞻性研究来评估老年患者非诊断性结肠镜检查的风险/益处。