Risk Factors for Aspiration Pneumonia in Ambulatory Endoscopy Patients Utilizing Marketscan Data: Presidential Poster

Abstract

Introduction: Although the 30-day mortality rate in patients undergoing endoscopy is low at 0.07% (1:1537 procedures), the increased volume of elective endoscopic procedures performed in ambulatory centers in recent years makes complications a significant concern. Pneumonia is one of the most common complications following endoscopy. In a prospective observational, multicenter study performed in outpatient practices, about 5% of patients reported at least one respiratory symptom after an endoscopic procedure, including cough, fever, and shortness of breath. In a retrospective populationbased study, aspiration pneumonia occurred following 0.10-0.14% of colonoscopies. It is presumed that deeper levels of sedation lead to diminished airway protection, thus increasing the risk of aspiration pneumonia; however, other risk factors for aspiration and pneumonia have not been investigated. Methods: Using a large private insurance claims database, we studied adults aged 18 years and older who underwent ambulatory endoscopies (EGD, colonoscopy, or sigmoidoscopy) in 2009 and 2010 complicated by aspiration or aspiration pneumonia within 30 days of endoscopy. Results: There were 4,926,668 adult patients who had an ambulatory endoscopy in 2009-2010, including 1,987,194 EGDs, 107,801 sigmoidoscopies, and 5,809,344 colonoscopies. Of these patients, 55,860 (1.1%) had a diagnosis of aspiration or pneumonia within 30 days after the procedure. The greatest predictor of pneumonia after endoscopy was having a history of pneumonia in the past year, which was associated with a 19-fold increased odds. Other predictors of aspiration included prior stroke (adjusted OR 2.0, 95% CI 1.81-2.12), dysphagia (adjusted OR 2.3, 95% CI 2.11-2.41), and congestive heart failure (adjusted OR 2.8, 95% CI 2.52-3.07). Use of anesthesiologists showed increased risk of pneumonia (adjusted OR 1.1, 95% CI 1.024-1.113). Multivariable analysis was adjusted for age, sex, geographic location, gastroesophageal reflux disease, diabetes, coronary artery disease, chronic obstructive pulmonary disease, obesity, obstructive sleep apnea, and asthma. Conclusion: In this cohort of patients undergoing ambulatory endoscopies, patients with history of pneumonia, stroke, dysphagia, congestive heart failure, and use of anesthesia had increased risk for aspiration and pneumonia. Further studies should be undertaken to investigate other trends that may lead to aspiration pneumonia in ambulatory endoscopy patients.Table 1: Predictors Of Procedural Complications In Univariate And Multivariate Analysis