title: Anaesthesia care for emergency endoscopy for peptic ulcer bleeding. A nationwide population-based cohort study.
abstract: OBJECTIVE
  Currently, no standard approach exists to the level of monitoring or presence of staff with anaesthetic expertise required during emergency esophago-gastro-duodenoscopy (EGD) for peptic ulcer bleeding (PUB). We assess the association between anaesthesia care and mortality. We further describe the prevalence and inter-hospital variation of anaesthesia care in Denmark and identify clinical predictors for choosing anaesthesia care.
  
  
  METHODS
  This population-based cohort study included all emergency EGDs for PUB in adults during 2012-2013. About 90-day all-cause mortality after EGD was estimated by crude and adjusted logistic regression. Clinical predictors of anaesthesia care were identified in another logistic regression model.
  
  
  RESULTS
  Some 3.056 EGDs performed at 21 hospitals were included; 2074 (68%) received anaesthesia care and 982 (32%) were managed under supervison of the endoscopist. Some 16.7% of the patients undergoing EGD with anaesthesia care died within 90 days after the procedure, compared to 9.8% of the patients who had no anaesthesia care, adjusted OR = 1.51 (95% CI = 1.25-1.83). Comparing the two hospitals with the most frequent (98.6% of al EGDs) and least frequent (6.9%) use of anaesthesia care, mortality was 13.7% and 11.7%, respectively, adjusted OR = 1.22 (95% CI = 0.55-2.71). The prevalence of anaesthesia care varied between the hospitals, median = 78.9% (range 6.9-98.6%). Predictors of choosing anaesthesia care were shock at admission, high ASA score, and no pre-existing comorbidity.
  
  
  CONCLUSIONS
  Use of anaesthesia care for emergency EGD was associated with increased mortality, most likely because of confounding by indication. The use of anaesthesia care varied greatly between hospitals, but was unrelated to mortality at hospital level.
authors.affiliation: a Department of Anaesthesiology and Intensive Care Medicine , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark ;
authors.forename: Patricia
authors.initials: P
authors.lastname: Duch
authors.affiliation: a Department of Anaesthesiology and Intensive Care Medicine , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark ;
authors.forename: Camilla
authors.initials: C
authors.lastname: Haahr
authors.affiliation: b Department of Intensive Care , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark ;
authors.forename: Morten Hylander
authors.initials: MH
authors.lastname: Møller
authors.affiliation: c Department of Gastroenterology, Surgical Unit , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark ;
authors.forename: Steffen J
authors.initials: SJ
authors.lastname: Rosenstock
authors.affiliation: a Department of Anaesthesiology and Intensive Care Medicine , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark ;
authors.forename: Nicolai B
authors.initials: NB
authors.lastname: Foss
authors.affiliation: d Department of Anaesthesiology and Intensive Care Medicine , Nordsjællands Hospital, Copenhagen University Hospital , Hillerød , Denmark.
authors.forename: Lars Hyldborg
authors.initials: LH
authors.lastname: Lundstrøm
authors.affiliation: a Department of Anaesthesiology and Intensive Care Medicine , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark ;
authors.forename: Nicolai
authors.initials: N
authors.lastname: Lohse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D015331:Cohort Studies; D003718:Denmark; D004384:Duodenoscopy; D004630:Emergencies; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis* / Q000401:mortality*; D012042:Registries
keywords: Anaesthesia care; cohort study; endoscopy; peptic ulcer bleeding