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A national study of cardiopulmonary unplanned events after GI endoscopy
Virender K Sharma1, Cuong C Nguyen, Michael D Crowell
1Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Scottsdale, Arizona 85259, and Oregon Health Sciences University, Portland, Oregon, USA.
Insights
Cardiopulmonary unplanned events (CUE) during GI endoscopy are linked to patient age, higher ASA class, inpatient status, and trainee involvement. Routine oxygen use also increases CUE risk, highlighting areas for improved patient safety protocols.
Area of Science:
- Gastroenterology
- Anesthesiology
- Patient Safety
Background:
- Cardiopulmonary unplanned events (CUE) are significant complications during gastrointestinal (GI) endoscopy under conscious sedation.
- Understanding the incidence and predictors of CUE is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the incidence of CUE during GI endoscopy.
- To identify factors that predict the occurrence of CUE in patients undergoing GI endoscopy.
Main Methods:
- Retrospective analysis of the Clinical Outcomes Research Initiative (CORI) database.
- Inclusion of 324,737 GI endoscopy procedures performed under conscious sedation.
- Logistic regression analysis to identify predictors of CUE.
Main Results:
- The overall incidence of CUE was 0.9% across all procedures.
- Significant predictors of CUE included older patient age, higher American Society of Anesthesiologists (ASA) class, inpatient status, and trainee participation.
- Non-university sites, Veterans Administration Medical Centers, and routine use of supplemental oxygen were also associated with increased CUE rates.
Conclusions:
- Patient age, higher ASA grade, inpatient status, trainee participation, and routine oxygen use are associated with a higher incidence of CUE during GI endoscopy with conscious sedation.
- These findings underscore the need for targeted safety measures and risk assessment in specific patient populations and procedural settings.
Background:
Cardiopulmonary unplanned events (CUE) related to conscious sedation constitute a major proportion of GI endoscopy-associated complications.
Objectives:
Our purpose was to study the incidence of CUE during GI endoscopy and to determine factors that may predict CUE.
Design:
Retrospective CORI (Clinical Outcomes Research Initiative) database review.
Patients:
Undergoing GI endoscopy under conscious sedation.
Main Outcome Measurement:
CUE associated with GI endoscopy.
Results:
Data on 324,737 unique procedures (EGD, 140,692; colonoscopy, 174,255; ERCP, 6092; and EUS, 3698) performed with the patient under conscious sedation were analyzed. Unplanned events were reported in 1.4% of procedures; 0.9% were associated with CUE. Rates of CUE with EGD, colonoscopy, ERCP, and EUS were 0.6%, 1.1%, 2.1%, and 0.9%, respectively. Multiple logistic regression revealed patient age (odds ratio [OR] 1.02, 95% CI 1.01-1.02) and ASA class were significant predictors of CUE (OR compared with ASA I: ASA II 1.05, 95% CI 0.95-1.16; ASA III 1.8, 95% CI 1.6-2.0, ASA IV 3.2, 95% CI 2.5-4.1, ASA V 7.5; 95% CI 3.2-17.6). Inpatient procedures were associated with higher CUE (OR 1.5, 95% CI 1.3-1.7). Compared with universities, nonuniversity sites (OR 1.2, 95% CI 1.1-1.4) and Veterans Administration Medical Centers (OR 1.4, 95% CI 1.2-1.5) had significantly higher CUE. Use of supplemental oxygen during a procedure was associated with significantly more CUE (OR 1.2, 95% CI 1.1-1.3). Involvement of a trainee with a procedure was also associated with higher CUE (OR 1.3, 95% CI 1.1-1.4).
Limitations:
Retrospective review of data entered voluntarily by endoscopists not trained on CORI data entry.
Conclusions:
During GI endoscopy with conscious sedation, patient's age, higher ASA grade, inpatient status, trainee participation, and routine use of oxygen are associated with a higher incidence of CUE.
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