Usman Tariq, MD, Jordan Gladys-Oryhon, DO, Ivana Deyl, MD, Dhruv Chaudhary, MD, Ragunath Appasamy, MD, PhD; Allegheny Health Network, Pittsburgh, PA
Introduction: Colonoscopies are the mainstay of colorectal cancer (CRC) screening. There is a paucity of data outlining adverse events and their respective predictors especially related to sedation. The goal of this quality improvement (QI) study is to identify the incidence of adverse events and their associated risk factors following screening colonoscopies at our institution. Methods: A retrospective chart review identifying randomly selected adult patients who underwent average risk CRC screening colonoscopy at our institution. Descriptive analyses were used to report frequency of clinically significant adverse events during the procedure which included desaturation (< 95%), airway change, arrhythmias, hypotension, aborted procedure, hospitalization, need for cardiopulmonary resuscitation and death. Multi-variate logistic regression analyses to identify risk factors associated with each adverse event was done. Co-variates of the model were selected a priori and include age, BMI, gender, smoking status and other co-morbidities. Results: A total of 304 patients were included in the study. The median age of the cohort was 58 years [IQR 52-65] and included 43% male (Table 1). 61% patients experienced at least one adverse event, including de-saturation (37.2%), airway change (15.5%), arrhythmias (11.8%), hypotension (19.4%), procedure abortion (8.6%), and hospitalization (1.0%). Need for CPR and death was not documented. Higher BMI was associated with developing oxygen de-saturation (OR 1.04 [95% CI 1.01-1.07]; p=0.004). Old age (OR 1.06 [95% CI 1.01-1.10]; p=0.009) and presence of airway change (OR 2.40 [95% CI 1.04-5.53]; p=0.04) was associated with higher odds of developing arrhythmia (Table 2). Developing de-saturation (OR 1.90 [95% CI 1.06-3.40]; p=0.031) and airway change (OR 2.64 [95% CI 1.32-5.28]; p=0.006) was associated with higher odds of hypotension. Male gender (OR 3.08 [95% CI 1.25-7.63]; p=0.015) and COPD (OR 9.96 [95% CI 3.63-27.30]; p< 0.001) were associated with higher odds of aborting procedure (Table 3). Discussion: As screening colonoscopies are increasingly performed, understanding the risk factors that can predispose patients to adverse outcomes is essential. Our study delineates multiple risk factors that increase the odds of poor outcome(s). Optimization of these risk factors prior to intervention can decrease adverse events. Further studies are needed to evaluate if less invasive screening methods are more appropriate for patients at high risk for these events.