Original article
Alimentary tract
Patient, Procedure, and Endoscopist Risk Factors for Perforation, Bleeding, and Splenic Injury After Colonoscopies

https://doi.org/10.1016/j.cgh.2018.08.005Get rights and content
Under a Creative Commons license
open access

Background & Aims

We investigated perforations, bleeding, and splenic injuries after screening or diagnostic colonoscopies to identify patient-, procedure-, endoscopist-, and facility-associated risk factors.

Methods

We analyzed data from the SNIIRAM-PMSI national claims databases in France. A total of 4,088,799 patients, 30 years or older, undergoing a first screening or diagnostic colonoscopy from 2010 through 2015 were identified. Rates of severe adverse events (SAEs) were estimated using stringent and broad definitions. Risk factors associated with perforations and major bleeding were estimated using multilevel logistic regression models, adjusted for patient, colonoscopy, and endoscopist characteristics.

Results

Perforation rates ranged from 3.5 (stringent definition) to 7.3 (broad definition) per 10,000 procedures, bleeding rates ranged from 6.5 to 23.1 per 10,000 procedures, and splenic injury rates ranged from 0.20 to 0.34 per 10,000 procedures. Rates of 30-day mortality were 13.2 per 1000 bleeds, 29.2 per 1000 perforations, and 36.1 per 1000 splenic injuries (stringent definitions). Patient characteristics associated with SAEs were increasing age (especially for perforation), cancer, and cardiovascular comorbidities. Procedure characteristics associated with SAEs included polypectomy—especially of polyps larger than 1 cm with an increased risk of perforation (odds ratio, 4.1; 95% CI, 3.4–5.0) and bleeding (odds ratio, 13.3; 95% CI, 11.7–15.1). Less-experienced endoscopists and endoscopists who performed a smaller number of colonoscopies were independently associated with a risk of SAEs.

Conclusion

In an analysis of national claims databases in France, we found SAEs related to screening and diagnostic colonoscopies to be more frequent in older patients, in patients with comorbidities, and with less-experienced endoscopists. Patients at risk of SAE should be identified and colonoscopies should be performed or supervised by experienced endoscopists.

Keywords

Colonoscopy Adverse Events
Comorbidity
Practitioner Characteristics
French Study

Abbreviations used in this paper

aOR
adjusted odds ratio
CI
confidence interval
DP
principal diagnosis
DR
related diagnosis
ICD-10
International Statistical Classification of Diseases-Tenth Revision
LTD
long term disease
MD
medical doctor
PMSI
French National Hospital Discharge Database
SAE
severe adverse event
SNIIRAM
French National Health Insurance Claims Information System

Cited by (0)

Conflicts of interest The authors disclose no conflicts.

Funding This research was funded by French National Health Insurance (CNAM).