531 Patients Undergoing Outpatient Upper Endoscopy and Colonoscopy on the Same Day (Double Procedures) Are at Increased Risk for Adverse Respiratory Outcomes

Abstract

INTRODUCTION: Between 11-15 million colonoscopies and 6-7 million upper endoscopies are performed in the United States annually, with over half the cases occurring in an ambulatory setting (1,2). Recent claims-based data has suggested that infectious complications may be increased when upper endoscopy and colonoscopy are performed together compared to when they are performed separately (3). The purpose of this study is to determine endoscopic and anesthesia variables that increase the risk of periprocedural respiratory complications. METHODS: Medical records from 2000 consecutive upper endoscopies and colonoscopies performed at five high volume ambulatory surgery centers were reviewed. Patient characteristics were recorded, along with endoscopic and anesthesia variables. End points chosen to serve as surrogates of aspiration risk were intra-procedure cough, desaturation, placement of a nasal or oral airway, and use of oral suction. RESULTS: In 2000 cases, desaturation occurred in 3.25%, cough in 3.5% cases, need for suction in 2.45%, and need for oral airway / nasal trumpet in 0.4%. Multiple logistic regression analysis demonstrated supine position, double procedure, bowel prep taken as a single dose, NPO time of less than 3 hours, BMI >35 kg/m2 and Propofol dose >300 mg, and supine position to be independent risk factors for adverse respiratory events. CONCLUSION: Supine position during procedures, double procedures, bowel prep taken as a single dose, NPO duration of less than 3 hours, high BMI and high propofol dose are risk factors for adverse respiratory outcomes during endoscopic procedures.