Jordan Gladys-Oryhon, DO, Ivana Deyl, MD, Usman Tariq, MD, Dhruv Chaudhary, MD, Ragunath Appasamy, MD, PhD; Allegheny Health Network, Pittsburgh, PA
Introduction: Average risk Colorectal Cancer (CRC) screening colonoscopy requires procedural sedation and monitored anesthesia care (MAC). Elevated BMI is associated with higher prevalence of comorbid conditions including obstructive sleep apnea, hypertension, and pulmonary hypertension. Pre-existing comorbidities, including obesity, may be associated with increased intraoperative cardiopulmonary (ICP) morbidity related to procedural sedation. The aim of our quality improvement project was to evaluate intraoperative morbidity associated with MAC during screening colonoscopy in obese patients. Methods: Data were collected by retrospective chart review of 304 randomly selected patients undergoing average risk CRC screening colonoscopy at Allegheny Health Network. Demographic data for obese (n=152) and non-obese (n=152) cohorts were collected (Table 1). BMI and intraoperative indices including arrhythmia, hypotension, and oxygen saturation, were extracted and analyzed using Pearson’s Chi-Squared Test. Independent T-Test was performed to compare average oxygen desaturation time (ODT). Results: 77.3% of patients were BMI 25-29.9 (27.3%), 30-40 (25.3%) and >40 (24.7%) (Table 1). 52.6% of obese patients experienced oxygen desaturation (SaO2 < 95%) as compared to 46.7% in non-obese patients, but this was not statistically significant. Obese patients did have lower mean initial SaO2 and statistically significant increased time with SaO2 < 95% (p=.007). There was no statistically significant association between obesity and intraoperative complications including hypotension, arrhythmia, and hypoxia. Discussion: Our study shows no statistically significant difference in ICP morbidity related to obesity(BMI >30), except for ODT. These findings suggest that patients with obesity are at higher risk of prolonged oxygen desaturation during MAC assisted colonoscopies. Further larger studies are needed to evaluate the clinical implications of prolonged ODT in obese patients.
Table 1. Patient demographics and comorbidities
Table 2. Rates of intraoperative cardiopulmonary complications in obese and non-obese patients while under MAC during screening colonoscopy.
Table 3A and 3B. 3A: T-test for Equality of Means showing statistically significant increased ODT minutes in obese patients; 3B: Obese vs. Non-Obese Group Statistics for intraprocedural oxygenation status.
Disclosures: Jordan Gladys-Oryhon indicated no relevant financial relationships. Ivana Deyl indicated no relevant financial relationships. Usman Tariq indicated no relevant financial relationships. Dhruv Chaudhary indicated no relevant financial relationships. Ragunath Appasamy indicated no relevant financial relationships.