Pre-endoscopy Anesthesiology Clinic Evaluation Does Not Reduce Adverse Event Rates for High-risk for Sedation...

Area of Science:

• Anesthesiology
• Gastroenterology
• Health Policy

Background:

• Preoperative evaluation is standard for surgery, but its role before endoscopic procedures is unclear.
• High-risk patients undergoing sedation for endoscopy were evaluated by anesthesiologists post-policy change.
• The study aimed to compare adverse events (AEs) between pre-policy and post-policy strategies.

Purpose of the Study:

• To compare the rates of adverse events (AEs) in high-risk patients undergoing endoscopic procedures before and after implementing pre-endoscopy anesthesiology evaluations.
• To assess the impact of a policy change on sedation-related adverse events in ambulatory endoscopic procedures.

Main Methods:

• Retrospective review of 18,240 ambulatory upper and lower endoscopies (2016-2017).
• Comparison of postprocedural emergency department admissions, hospitalizations, operations, and mortality before (BPC) and after (APC) the policy change.
• Analysis focused on patients undergoing anesthesiologist-supervised endoscopic procedures (ASEP).

Main Results:

• Post-policy change, anesthesiology clinic assessments increased significantly (2.03% to 51.22%).
• Sedation-related adverse events were comparable between the periods (0.07% BPC vs. 0.03% APC), with no significant difference (P=0.256).
• The proportion of anesthesiologist-supervised endoscopic procedures remained similar between periods.

Conclusions:

• The policy change for pre-endoscopy evaluation in high-risk patients did not alter adverse event rates.
• Limited policy adherence may have contributed to the lack of observed benefit.
• The findings suggest a marginal impact on an already low event rate for high-risk patients undergoing these procedures.