title: Complications following colonoscopy with anesthesia assistance: a population-based analysis.
abstract: OBJECTIVE
  Deep sedation for endoscopic procedures has become an increasingly used option but, because of impairment in patient response, this technique also has the potential for a greater likelihood of adverse events. The incidence of these complications has not been well studied at a population level.
  
  
  METHODS
  Population-based study.
  
  
  METHODS
  Using a 5% random sample of cancer-free Medicare beneficiaries who resided in one of the regions served by a SEER (Surveillance, Epidemiology, and End Results) registry, we identified all procedural claims for outpatient colonoscopy without polypectomy from January 1, 2000, through November 30, 2009.
  
  
  METHODS
  Colonoscopy without polypectomy, with or without the use of deep sedation (identified by a concurrent claim for anesthesia services).
  
  
  METHODS
  The occurrence of hospitalizations for splenic rupture or trauma, colonic perforation, and aspiration pneumonia within 30 days of the colonoscopy.
  
  
  RESULTS
  We identified a total of 165 527 procedures in 100 359 patients, including 35 128 procedures with anesthesia services (21.2%). Selected postprocedure complications were documented after 284 procedures (0.17%) and included aspiration (n = 173), perforation (n = 101), and splenic injury (n = 12). (Some patients had >1 complication.) Overall complications were more common in cases with anesthesia assistance (0.22% [95% CI, 0.18%-0.27%]) than in others (0.16% [0.14%-0.18%]) (P < .001), as was aspiration (0.14% [0.11%-0.18%] vs 0.10% [0.08%-0.12%], respectively; P = .02). Frequencies of perforation and splenic injury were statistically similar. Other predictors of complications included age greater than 70 years, increasing comorbidity, and performance of the procedure in a hospital setting. In multivariate analysis, use of anesthesia services was associated with an increased complication risk (odds ratio, 1.46 [95% CI, 1.09-1.94]).
  
  
  CONCLUSIONS
  Although the absolute risk of complications is low, the use of anesthesia services for colonoscopy is associated with a somewhat higher frequency of complications, specifically, aspiration pneumonia. The differences may result in part from uncontrolled confounding, but they may also reflect the impairment of normal patient responses with the use of deep sedation.
authors.affiliation: Division of Gastroenterology, University Hospitals Case Medical Center, Cleveland, OH 44106, USA. gregory.cooper@uhhospitals.org
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Cooper
authors.forename: Tzuyung D
authors.initials: TD
authors.lastname: Kou
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Rex
mesh_terms: D000368:Aged; D003106:Colon / Q000293:injuries; D003113:Colonoscopy; D054810:Deep Sedation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology; D008297:Male; D011015:Pneumonia, Aspiration / Q000209:etiology; D011183:Postoperative Complications; D018426:SEER Program; D013161:Splenic Rupture / Q000209:etiology