Anaesthesia care with and without tracheal intubation during emergency endoscopy for peptic ulcer bleeding: a population-based cohort study.
BACKGROUND
Emergency upper gastrointestinal bleeding is a common condition with high mortality. Most patients undergo oesophagogastroduodenoscopy (OGD), but no universally agreed approach exists to the type of airway management required during the procedure. We aimed to compare anaesthesia care with tracheal intubation (TI group) and without airway instrumentation (monitored anaesthesia care, MAC group) during emergency OGD.


METHODS
This was a prospective, nationwide, population-based cohort study during 2006-13. Emergency OGDs performed under anaesthesia care were included. End points were 90 day mortality (primary) and length of stay in hospital (secondary). Associations between exposure and outcomes were assessed in logistic and linear regression models, adjusted for the following potential confounders: shock at admission, level of anaesthetic expertise present, ASA score, Charlson comorbidity index score, BMI, age, sex, alcohol use, referral origin (home or in-hospital), Forrest classification, ulcer localization, and postoperative care.


RESULTS
The study group comprised 3580 patients under anaesthesia care: 2101 (59%) for the TI group and 1479 (41%) for the MAC group. During the first 90 days after OGD, 18.9% in the TI group and 18.4% in the MAC group died, crude odds ratio=1.03 [95% confidence interval (CI)=0.87-1.23, P=0.701], adjusted odds ratio=0.95 (95% CI=0.79-1.15, P=0.590). Patients in the TI group stayed slightly longer in hospital [mean 8.16 (95% CI=7.63-8.60) vs 7.63 days (95%=CI 6.92-8.33), P=0.108 in adjusted analysis].


CONCLUSIONS
In this large population-based cohort study, anaesthesia care with TI was not different from anaesthesia care without airway instrumentation in patients undergoing emergency OGD in terms of 90 day mortality and length of hospital stay.
Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Hvidovre, Kettegaards Alle 30, DK-2650 Hvidovre, Denmark niclohse@gmail.com.
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Lohse
Department of Anaesthesiology and Intensive Care Medicine, Nordsjællands Hospital, Copenhagen University Hospital, Hillerød, Dyrehave 29, DK-3400 Hillerød, Denmark.
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Lundstrøm
Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Hvidovre, Kettegaards Alle 30, DK-2650 Hvidovre, Denmark.
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Vestergaard
Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Hvidovre, Kettegaards Alle 30, DK-2650 Hvidovre, Denmark.
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Risom
Department of Surgical Gastroenterology, Copenhagen University Hospital Hvidovre, Kettegaards Alle 30, DK-2650 Hvidovre, Denmark.
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Rosenstock
Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Hvidovre, Kettegaards Alle 30, DK-2650 Hvidovre, Denmark.
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Foss
Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Hvidovre, Kettegaards Alle 30, DK-2650 Hvidovre, Denmark Department of Intensive Care, 4131, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
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Møller
D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D015331:Cohort Studies; D016208:Databases, Factual; D003718:Denmark / Q000453:epidemiology; D004632:Emergency Medical Services / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods* / Q000401:mortality; D023381:Endpoint Determination; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007442:Intubation, Intratracheal; D008136:Longevity; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000401:mortality / Q000628:therapy*; D011153:Population; D011182:Postoperative Care; D011446:Prospective Studies; D012042:Registries
cohort study; gastroscopy; intubation; mortality