title: Risks Associated With Anesthesia Services During Colonoscopy.
abstract: OBJECTIVE
  We aimed to quantify the difference in complications from colonoscopy with vs without anesthesia services.
  
  
  METHODS
  We conducted a prospective cohort study and analyzed administrative claims data from Truven Health Analytics MarketScan Research Databases from 2008 through 2011. We identified 3,168,228 colonoscopy procedures in men and women, aged 40-64 years old. Colonoscopy complications were measured within 30 days, including colonic (ie, perforation, hemorrhage, abdominal pain), anesthesia-associated (ie, pneumonia, infection, complications secondary to anesthesia), and cardiopulmonary outcomes (ie, hypotension, myocardial infarction, stroke), adjusted for age, sex, polypectomy status, Charlson comorbidity score, region, and calendar year.
  
  
  RESULTS
  Nationwide, 34.4% of colonoscopies were conducted with anesthesia services. Rates of use varied significantly by region (53% in the Northeast vs 8% in the West; P < .0001). Use of anesthesia service was associated with a 13% increase in the risk of any complication within 30 days (95% confidence interval [CI], 1.12-1.14), and was associated specifically with an increased risk of perforation (odds ratio [OR], 1.07; 95% CI, 1.00-1.15), hemorrhage (OR, 1.28; 95% CI, 1.27-1.30), abdominal pain (OR, 1.07; 95% CI, 1.05-1.08), complications secondary to anesthesia (OR, 1.15; 95% CI, 1.05-1.28), and stroke (OR, 1.04; 95% CI, 1.00-1.08). For most outcomes, there were no differences in risk with anesthesia services by polypectomy status. However, the risk of perforation associated with anesthesia services was increased only in patients with a polypectomy (OR, 1.26; 95% CI, 1.09-1.52). In the Northeast, use of anesthesia services was associated with a 12% increase in risk of any complication; among colonoscopies performed in the West, use of anesthesia services was associated with a 60% increase in risk.
  
  
  CONCLUSIONS
  The overall risk of complications after colonoscopy increases when individuals receive anesthesia services. The widespread adoption of anesthesia services with colonoscopy should be considered within the context of all potential risks.
authors.affiliation: Group Health Research Institute, Seattle, Washington; Department of Health Services, University of Washington, Seattle, Washington. Electronic address: wernli.k@ghc.org.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Wernli
authors.affiliation: Department of Health Services, University of Washington, Seattle, Washington; Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: Alison T
authors.initials: AT
authors.lastname: Brenner
authors.affiliation: Group Health Research Institute, Seattle, Washington; RAND Corporation, Santa Monica, California.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Rutter
authors.affiliation: Department of Health Services, University of Washington, Seattle, Washington; Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: John M
authors.initials: JM
authors.lastname: Inadomi
mesh_terms: D000328:Adult; D000758:Anesthesia / Q000009:adverse effects* / Q000379:methods; D003113:Colonoscopy / Q000009:adverse effects* / Q000379:methods; D016208:Databases, Factual; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States
keywords: Anesthesia Services; Endoscopy; Gastroenterology; Propofol