GI Endoscopy At Ambulatory Surgical Centers Is Safe: Review of 7979 Consecutive Procedures

Abstract

Background: The number of procedures performed at ambulatory surgical centers (ASCs) has increased markedly over recent years. Limited data are available regarding the safety of endoscopy in this setting, particularly in the elderly and in those with cardiopulmonary comorbidities. Moreover, prior studies have focused on endoscopic complications; sedation related complications have not been studied. Aim: To assess the safety of endoscopy at an ASC. Methods: The study was performed at an ASC with a physician staffed quality assurance committee (QAC) which discusses every endoscopic complication. Endoscopic complication data were extracted from QAC meeting minutes, mandatory monthly physician self-reports of complications, post-procedure follow-up phone calls, mail-in post-procedure patient questionnaires, and hospitalization records. In addition, to overcome inherent limitations of physician/nurse reporting of minor sedation related complications, a sub-set of primary patient charts comprising the most recent 1000 consecutive cases were individually reviewed, and data were extracted from peri-procedural nursing/physician notes and procedure reports. Results: 7979 GI endoscopic procedures (80% colonoscopies and 20% EGDs approx) were performed from 2003-2006 by 8 endoscopists. Major endoscopic complications included 2 colonic perforations (0.03% approx), 1 duodenal perforation (0.06% approx), 2 delayed post-polypectomy bleeds (0.03% approx), 4 serious cardiac arrhythmias (0.05%) with 3 resulting in transfer to a hospital. There were no deaths. Over time, the complication rate decreased, suggesting a positive impact of the QAC. Subanalysis of the most recent 1000 consecutive endoscopic procedures revealed 26% were therapeutic. 44% of procedures were performed in males. Median patient age was 56 years (range 19-88). 19% of procedures were performed in patients aged ≥70 years and 16% in patients with significant cardiopulmonary disease. Minor sedation related complications resulting in reversal agent use were noted in 0.8% of procedures, including 3 cases of sustained desaturation and 5 of significant bradycardia. All these patients were discharged home. Patients aged ≥70 were not more likely to develop sedation related complications than those <70. Cardiopulmonary comorbidities did not influence the complication rate. Conclusions: 1. GI endoscopy can be performed safely at ASCs with low complication rates. 2. Older patients and those with significant cardiopulmonary comorbidities did not have higher complication rates. 3. QACs may have a positive impact on complication rates. None of the authors of this study have any financial interest in the ASC.