Skip to main content

Advertisement

SpringerLink
Log in

Patients over Age 75 Are at Increased Risk of Emergency Department Visit and Hospitalization Following Colonoscopy

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

ED:

Emergency department

IBD:

Inflammatory bowel disease

BIDMC:

Beth Israel Deaconess Medical Center

EMR:

Endoscopic mucosal resection

References

  1. Howlader N, Noone AM, Krapcho M, et al., eds. SEER cancer statistics review, 1975–2013. National Cancer Institute. https://seer.cancer.gov/csr/1975_2013/. Accessed February 21, 2017.

  2. Inadomi JM. Screening for colorectal neoplasia. N Engl J Med. 2017;376:149–156.

    Article  Google Scholar 

  3. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329:1977–1981.

    Article  CAS  Google Scholar 

  4. Zauber AG, Winawer SJ, O’brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366:687–696.

    Article  CAS  Google Scholar 

  5. Rex DK, Johnson DA, Anderson JC, et al. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009;104:739–750.

    Article  Google Scholar 

  6. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology. Colorectal cancer screening version 1. 2015. https://www.tri-kobe.org/nccn/guideline/colorectal/english/colorectal_screening.pdf. Accessed February 21, 2017.

  7. Qaseem A, Denberg TD, Hopkins RH Jr, et al. Screening for colorectal cancer: a guidance statement from the American College of Physicians. Ann Intern Med. 2012;156:378–386.

    Article  Google Scholar 

  8. Tang V, Boscardin WJ, Stijacic-Cenzer I, et al. Time to benefit for colorectal cancer screening: survival meta-analysis of flexible sigmoidoscopy trials. BMJ. 2015;16:350:h1662.

    Google Scholar 

  9. Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Screening for colorectal cancer: US Preventative Services Task Force recommendation statement. JAMA. 2016;315:2564–2575.

    Article  CAS  Google Scholar 

  10. Schoen RE. PRO: screening colonoscopy is reasonable on an 88-year-old healthy patient. Am J Gastroenterol. 2006;101:1713–1715.

    Article  Google Scholar 

  11. Cooper GS. CON: screening colonoscopy in the extreme elderly is not a wise choice. Am J Gastroenterol. 2006;101:1715–1717.

    Article  Google Scholar 

  12. Crispin A, Birkner B, Munte A, et al. Process quality and incidence of acute complications in a series of more than 230,000 outpatient colonoscopies. Endoscopy. 2009;41:1018–1025.

    Article  CAS  Google Scholar 

  13. Rabeneck L, Paszat LF, Hilsden RJ, et al. Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology. 2008;135:1899–1906.

    Article  Google Scholar 

  14. Warren JL, Klabunde CN, Mariotto AB, et al. Adverse events after outpatient colonoscopy in the Medicare population. Ann Intern Med. 2009;150:849–857.

    Article  Google Scholar 

  15. Singh H, Penfold RB, Decoster C, et al. Colonoscopy and its complications across a Canadian regional health authority. Gastrointest Endosc. 2009;69:665–671.

    Article  Google Scholar 

  16. Leffler DA, Kheraj R, Garud S, et al. The incidence and cost of unexpected hospital use after scheduled outpatient endoscopy. Arch Intern Med. 2010;170:1752–1757.

    Article  Google Scholar 

  17. Baudet JS, Diaz-Bethencourt D, Aviles J, et al. Minor adverse events of colonoscopy on ambulatory patients: the impact of moderate sedation. Eur J Gastroenterol Hepatol. 2009;21:656–661.

    Article  Google Scholar 

  18. Ko CW, Riffle S, Shapiro JA, et al. Incidence of minor complications and time lost from normal activities after screening or surveillance colonoscopy. Gastrointest Endosc. 2007;65:648–656.

    Article  Google Scholar 

  19. Arora A, Singh P. Colonoscopy in patients 80 years of age and older is safe, with high success rate and diagnostic yield. Gastrointest Endosc. 2004;60:408–413.

    Article  Google Scholar 

  20. Karejeh MA, Sanders DS, Hurlstone DP. Colonoscopy in elderly people is a safe procedure with a high diagnostic yield: a prospective comparative study of 2000 patients. Endoscopy. 2006;38:226–230.

    Article  Google Scholar 

  21. Van Hees F, Habbema JD, Meester RG, et al. Should colorectal cancer screening be considered in elderly persons without previous screening? A cost-effectiveness analysis. Ann Intern Med. 2014;160:750–759.

    Article  Google Scholar 

  22. Lin OS, Kozarek RA, Schembre DB, et al. Screening colonoscopy in very elderly patients: prevalence of neoplasia and estimated impact on life expectancy. JAMA. 2006;295:2357–2365.

    Article  CAS  Google Scholar 

  23. Mittal S, Lin YL, Tan A, et al. Limited life expectancy among a subgroup of medicare beneficiaries receiving screening colonoscopies. Clin Gastroenterol Hepatol. 2014;12:443–450.

    Article  Google Scholar 

  24. Day LW, Kwon A, Inadomi JM, et al. Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis. Gastrointest Endosc. 2011;74:885–896.

    Article  Google Scholar 

  25. Cha JM, Kozarek RA, La Selva D. Risks and benefits of colonoscopy in patients 90 years or older, compared with younger patients. Clin Gastroenterol Hepatol. 2016;14:80–86.

    Article  Google Scholar 

  26. Chukmaitov A, Siangphoe U, Dahman B, Bradley CJ, BouHaidar D. Patient cormorbidity and serious adverse events after outpatient colonoscopy: population-based study from three states, 2006–2009. Dis Colon Rectum. 2016;59:677–687.

    Article  Google Scholar 

  27. García-Albéniz X, Hsu J, Bretthauer M, et al. Effectiveness of screening colonoscopy to prevent colorectal cancer among medicare beneficiaries aged 70 to 79 years: a prospective observational study. Ann Intern Med. 2017;166:18–26.

    Article  Google Scholar 

  28. Rex DK, Schoenfeld PS, Cohen J, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2015;81:31–53.

    Article  Google Scholar 

  29. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360:1418–1428.

    Article  CAS  Google Scholar 

  30. Hansen LO, Young RS, Hinami K, et al. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med. 2011;155:520–528.

    Article  Google Scholar 

  31. Duseja R, Bardach NS, Lin GA, et al. Revisit rates and associated costs after an emergency department encounter: a multistate analysis. Ann Intern Med. 2015;162:750–756.

    Article  Google Scholar 

  32. Graham KL, Wilker EH, Howell MD, et al. Differences between early and late readmissions among patients: a cohort study. Ann Intern Med. 2015;162:741–749.

    Article  Google Scholar 

  33. Ranasinghe I, Parzynski CS, Searfoss R, et al. Differences in colonoscopy quality among facilities: development of a post-colonoscopy risk-standardized rate of unplanned hospital visits. Gastroenterology. 2016;150:103–113.

    Article  Google Scholar 

  34. Grossberg LB, Vodonos A, Papamichael K, et al. Predictors of post colonoscopy emergency department utilization. Gastrointest Endosc. 2018;87:517–525.

    Article  Google Scholar 

  35. Rabeneck L, Saskin R, Paszat LF. Onset and clinical course of bleeding and perforation after outpatient colonoscopy: a population-based study. Gastrointest Endosc. 2011;73:520–523.

    Article  Google Scholar 

  36. Ko CW, Riffle S, Michaels L, et al. Serious complications within 30 days of screening and surveillance colonoscopy are uncommon. Clin Gastroenterol Hepatol. 2010;8:166–173.

    Article  Google Scholar 

Download references

Funding

There was no grant support provided for this manuscript.

Author information

Authors and Affiliations

  1. Lahey Hospital and Medical Center, Tufts Medical School, 41 Mall Road, Burlington, MA, 01805, USA

    Laurie B. Grossberg

  2. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Konstantinos Papamichael, Daniel A. Leffler, Mandeep S. Sawhney & Joseph D. Feuerstein

Authors
  1. Laurie B. Grossberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Konstantinos Papamichael
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniel A. Leffler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mandeep S. Sawhney
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joseph D. Feuerstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Laurie B. Grossberg.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 26 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Grossberg, L.B., Papamichael, K., Leffler, D.A. et al. Patients over Age 75 Are at Increased Risk of Emergency Department Visit and Hospitalization Following Colonoscopy. Dig Dis Sci 65, 1964–1970 (2020). https://doi.org/10.1007/s10620-019-05962-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-019-05962-3

Keywords

Search

Navigation