Association of polypectomy techniques, endoscopist volume, and facility type with colonoscopy complications

Abstract

Background and objective: Serious GI adverse events in the outpatient setting were examined by polypectomy technique, endoscopist volume, and facility type (ambulatory surgery center and hospital outpatient department).

Design: Retrospective follow-up study.

Setting: Ambulatory surgery and hospital discharge datasets from Florida (1997-2004) were used.

Patients: A total of 2,315,126 outpatient colonoscopies performed in patients of all ages and payers were examined.

Main outcome: Thirty-day hospitalizations because of colonic perforations and GI bleeding, measured as cumulative and specific outcomes, were investigated.

Results: Compared with simple colonoscopy, the adjusted risks of cumulative adverse events were greater with the use of cold forceps (1.21 [95% CI, 1.01-1.44]), ablation (3.75 [95% CI, 2.97-4.72]), hot forceps (5.63 [95% CI, 4.97-6.39]), snares (7.75 [95% CI, 6.95-8.64]), or complex colonoscopy (8.83 [95% CI, 7.70-10.12]). Low-volume endoscopists had higher risks of adverse events (1.18 [95% CI, 1.07-1.30]). A higher risk of adverse events was associated with procedures performed in ambulatory surgery centers (1.27 [95% CI, 1.16-1.40]). Important findings were also reported for the analyses stratified by specific outcomes and procedures.

Limitation: The study was constrained by limitations inherent in administrative data pertaining to a single state.

Conclusions: As the complexity of polypectomy increases, a higher risk of adverse events is reported. Using lower risk procedures when clinically appropriate or referring patients to high-volume endoscopists can reduce the rates of perforations and GI bleeding. Given the large number of colonoscopies performed in the United States, it is critical that the rates of adverse events be considered when choosing procedures.

Figure 1

Analytical sample. ASC, ambulatory surgery center; HOPD, hospital outpatient department.