title: Distance from hospital impacts adverse event detection after outpatient endoscopy.
abstract: OBJECTIVE
  Monitoring adverse events (AEs) after GI endoscopy is an endorsed quality measure but is challenging to implement in practice. Patients with major AEs may seek care elsewhere after endoscopy. We aimed to determine the hospital utilization patterns of patients with AEs after ambulatory endoscopy.
  
  
  METHODS
  We used the HealthLNK Data Repository, which uses a software application for integration of deidentified, patient-level clinical data across institutions. Data for patients undergoing outpatient endoscopy from 2010 to 2011 at 5 Chicago-area hospitals were used. Early mortality was defined as death no more than 2 months after the outpatient procedure. AEs were defined as a hospital admission for perforation, bleeding, or pancreatitis the same or following month after endoscopy.
  
  
  RESULTS
  During the study period, 42,842 outpatient procedures were performed in 22,898 unique individuals. Early mortality occurred in 86 patients (.4%). Per-patient mortality was greatest after outpatient ERCP (2.5%, P < .0001). Of 86 patients with early mortality, 36 (42%) were not hospitalized at the index hospital after endoscopy. Patients who did not return to the index hospital lived farther from the index hospital (P = .02). In total, 8.3% of ambulatory endoscopies were associated with potential endoscopy-related AEs. The observed rate of potential AEs trended downward as patients' home zip codes moved farther from the index hospital (P = .01).
  
  
  CONCLUSIONS
  Nearly half of patients who die soon after outpatient endoscopy are not hospitalized at their index hospital after endoscopy. The observed AE rate was higher for patients living closer to the index hospital, suggesting that patients who live farther away are less likely to return to the index hospital for emergency care. Novel methods to efficiently track outcomes after outpatient endoscopy are needed.
authors.affiliation: Center for Health Information Partnerships, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Jackson
authors.affiliation: Center for Health Information Partnerships, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Satyender
authors.initials: S
authors.lastname: Goel
authors.affiliation: Center for Health Information Partnerships, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Abel N
authors.initials: AN
authors.lastname: Kho
authors.affiliation: Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Rajesh N
authors.initials: RN
authors.lastname: Keswani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D002641:Chicago; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003625:Data Collection; D016208:Databases, Factual; D004636:Emergency Service, Hospital; D016145:Endoscopy, Digestive System; D004939:Esophageal Perforation / Q000453:epidemiology; D005260:Female; D005843:Geography; D006761:Hospitals; D006801:Humans; D007416:Intestinal Perforation / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010195:Pancreatitis / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D055815:Young Adult