title: Perforations and haemorrhages after colonoscopy in 2010: a study based on comprehensive French health insurance data (SNIIRAM).
abstract: OBJECTIVE
  To estimate the perforation and haemorrhage rate after colonoscopy in the French population in 2010 and to identify risk factors for these complications.
  
  
  METHODS
  Study based on SNIIRAM and the PMSI databases. Patients treated for IBD or colorectal cancer were excluded. Two types of complications were investigated: perforation and haemorrhage. OR adjusted for patient (gender, age, chronic disease) and colonoscopy (polypectomy, emergency) characteristics were calculated by using a logistic regression model.
  
  
  RESULTS
  The cohort was composed of 947,061 individuals. The estimated perforation rate was between 4.5 and 9.7 per 10,000 procedures and the estimated haemorrhage rate was between 9.9 and 11.0 per 10,000 procedures. The main risk factors associated with perforation and haemorrhage were the patient's age (over 80 years compared to under 40, OR=7.51 and 3.23), resection of polyps larger than 1 cm or more than 4 polyps (compared to no polypectomy, OR=2.72 and 5.12) and emergency colonoscopy (OR=4.63 and 5.99). Colonoscopy performed by a gastroenterologist performing less than 244 colonoscopies per year was associated with an increased risk of perforation (OR=2.29). Complication rates were higher in institutions performing less than 510 colonoscopies per year, but this was no longer the case after adjustment for emergency colonoscopies.
  
  
  CONCLUSIONS
  This study, which includes nearly one million colonoscopies, suggests taking the gastroenterologist's number of colonoscopies into account to ensure optimal organization of the management of very elderly patients requiring colonoscopy.
authors.affiliation: Strategy and Research Department, National Health Insurance (CNAMTS), 50, avenue du Pr-André-Lemierre, 75986 Paris cedex 20, France. Electronic address: pierre-olivier.blotiere@cnamts.fr.
authors.forename: Pierre-Olivier
authors.initials: PO
authors.lastname: Blotière
authors.affiliation: Strategy and Research Department, National Health Insurance (CNAMTS), 50, avenue du Pr-André-Lemierre, 75986 Paris cedex 20, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Weill
authors.affiliation: Strategy and Research Department, National Health Insurance (CNAMTS), 50, avenue du Pr-André-Lemierre, 75986 Paris cedex 20, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ricordeau
authors.affiliation: General Division, National Health Insurance (CNAMTS), 50, avenue du Pr-André-Lemierre, 75986 Paris cedex 20, France.
authors.forename: François
authors.initials: F
authors.lastname: Alla
authors.affiliation: General Division, National Health Insurance (CNAMTS), 50, avenue du Pr-André-Lemierre, 75986 Paris cedex 20, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Allemand
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000009:adverse effects*; D005260:Female; D005602:France; D006801:Humans; D007348:Insurance, Health; D007416:Intestinal Perforation / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology*; D012307:Risk Factors