title: Safety of sedation for gastrointestinal endoscopy in a group of university-affiliated hospitals: a prospective cohort study.
abstract: BACKGROUND
  Service models for gastrointestinal endoscopy sedation must be safe, as endoscopy is the most common procedure performed under sedation in many countries. The aim of this prospective cohort study was to determine the patient risk profile, and incidence of and risk factors for significant unplanned events, in adult patients presenting for gastrointestinal endoscopy in a group of university-affiliated hospitals where most sedation is managed by anaesthetists.
  
  
  METHODS
  Patients aged ≥18 yr presenting for elective and emergency gastrointestinal endoscopy under anaesthetist-managed sedation at nine hospitals affiliated with the University of Melbourne, Australia, were included. Outcomes included significant airway obstruction, hypoxia, hypotension and bradycardia; unplanned tracheal intubation; abandoned procedure; advanced life support; prolonged post-procedure stay; unplanned over-night admission and 30-day mortality.
  
  
  RESULTS
  2,132 patients were included. Fifty percent of patients were aged >60 yr, 50% had a BMI >27 kg m-2, 42% were ASA physical status III-V and 17% were emergency patients. The incidence of significant unplanned events was 23.0% (including significant hypotension 11.8%). Significant unplanned intraoperative events were associated with increasing age, BMI <18.5 kg m-2, ASA physical status III-V, colonoscopy and planned tracheal intubation. Thirty-day mortality was 1.2% (0.2% in electives and 6.0% in emergencies) and was associated with ASA physical status IV-V and emergency status.
  
  
  CONCLUSIONS
  Patients presenting for gastrointestinal endoscopy at a group of public university-affiliated hospitals where most sedation is managed by anaesthetists, had a high risk profile and a substantial incidence of significant unplanned intraoperative events and 30-day mortality.
authors.affiliation: Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia kate.leslie@mh.org.au.|Anaesthesia, Perioperative and Pain Medicine Unit, University of Melbourne, Melbourne, Australia.|Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Australia.|Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Leslie
authors.affiliation: Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia.|Anaesthesia, Perioperative and Pain Medicine Unit, University of Melbourne, Melbourne, Australia.|Department of Cancer Anaesthesia, Pain and Perioperative Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: M L
authors.initials: ML
authors.lastname: Allen
authors.affiliation: Anaesthesia, Perioperative and Pain Medicine Unit, University of Melbourne, Melbourne, Australia.|Department of Anaesthesia and Pain Medicine, Western Hospital, Melbourne, Australia.
authors.forename: E C
authors.initials: EC
authors.lastname: Hessian
authors.affiliation: Department of Anaesthesia, Austin Hospital, Melbourne, Australia.|Department of Surgery, University of Melbourne, Melbourne, Australia.
authors.forename: P J
authors.initials: PJ
authors.lastname: Peyton
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Kasza
authors.affiliation: Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Courtney
authors.affiliation: Department of Cancer Anaesthesia, Pain and Perioperative Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: P A
authors.initials: PA
authors.lastname: Dhar
authors.affiliation: Department of Anaesthesia and Perioperative Medicine, Northern Hospital, Melbourne, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Briedis
authors.affiliation: Department of Anaesthesia and Perioperative Medicine, Northern Hospital, Melbourne, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Anaesthesia, Goulburn Valley Base Hospital, Shepparton, Australia.
authors.forename: A R
authors.initials: AR
authors.lastname: Beeton
authors.affiliation: Department of Anaesthesia, Goulburn Valley Base Hospital, Shepparton, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Sayakkarage
authors.affiliation: Department of Anaesthesia, Ballarat Base Hospital, Ballarat, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Palanivel
authors.affiliation: Department of Anaesthesia, St Vincent's Hospital, Melbourne, Australia.
authors.forename: J K
authors.initials: JK
authors.lastname: Taylor
authors.affiliation: Department of Anaesthesia, Wangaratta Base Hospital, Wangaratta, Australia.
authors.forename: A J
authors.initials: AJ
authors.lastname: Haughton
authors.affiliation: Department of Anaesthesia, Wangaratta Base Hospital, Wangaratta, Australia.
authors.forename: C X
authors.initials: CX
authors.lastname: O'Kane
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D016292:Procedural Sedation / Q000009:adverse effects*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011446:Prospective Studies; D055815:Young Adult
keywords: anaesthesia, complications; gastrointestinal endoscopy; sedation