The incidence and cost of unexpected hospital use after scheduled outpatient endoscopy.
BACKGROUND
Data on complications of gastrointestinal endoscopic procedures are limited. We evaluated prospectively the incidence and cost of hospital visits resulting from outpatient endoscopy.


METHODS
We developed an electronic medical record-based system to record automatically admissions to the emergency department (ED) within 14 days after endoscopy. Physicians evaluated all reported cases for relatedness of the ED visit to the prior endoscopy based on predetermined criteria.


RESULTS
We evaluated 6383 esophagogastroduodenoscopies (EGDs) and 11 632 colonoscopies (7392 for screening and surveillance). Among these, 419 ED visits and 266 hospitalizations occurred within 14 days after the procedure. One hundred thirty-four (32%) of the ED visits and 76 (29%) of the hospitalizations were procedure related, whereas 31 complications were recorded by standard physician reporting (P < .001). Procedure-related hospital visits occurred in 1.07%, 0.84%, and 0.95% of all EGDs, all colonoscopies, and screening colonoscopies, respectively. The mean costs were $1403 per ED visit and $10 123 per hospitalization based on Medicare standardized rates. Across the overall screening/surveillance colonoscopy program, these episodes added $48 per examination.


CONCLUSIONS
Using a novel automated system, we observed a 1% incidence of related hospital visits within 14 days of outpatient endoscopy, 2- to 3-fold higher than recent estimates. Most events were not captured by standard reporting, and strategies for automating adverse event reporting should be developed. The cost of unexpected hospital visits postendoscopy may be significant and should be taken into account in screening or surveillance programs.
Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. dleffler@caregroup.harvard.edu
Daniel A
DA
Leffler
Rakhi
R
Kheraj
Sagar
S
Garud
Naama
N
Neeman
Larry A
LA
Nathanson
Ciaran P
CP
Kelly
Mandeep
M
Sawhney
Bruce
B
Landon
Richard
R
Doyle
Stanley
S
Rosenberg
Mark
M
Aronson
D001071:Appointments and Schedules; D004636:Emergency Service, Hospital / Q000191:economics* / Q000592:standards; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects* / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology