The impact of anesthesia providers on major morbidity following screening colonoscopies

Abstract

Background and aims

Few studies evaluate the impact of anesthesia providers during procedures, such as colonoscopy, on low-risk patients. The objective of this study was to compare the effect of anesthesia providers on several outcome variables, including major morbidity, following screening colonoscopies.

Methods

A propensity-matched cohort study of 14,006 patients who enrolled with a national insurer offering health maintenance organization (HMO), preferred provider organization (PPO), and Medicare Advantage plans for a screening colonoscopy between July 1, 2005 and June 30, 2007 were studied. Records were evaluated for completion of the colonoscopy, new cancer diagnosis (colon, anal, rectal) within 6 months of the colonoscopy, new primary diagnosis of myocardial infarction (MI), new primary diagnosis of stroke, hospital admission within 7 days of the colonoscopy, and adherence to guidelines for use of anesthesia providers.

Results

The presence of an anesthesia provider did not affect major morbidity or the percent of completed exams. Overall morbidity within 7 days was very low. When an anesthesia provider was present, a nonsignificant trend toward greater cancer detection within 6 months of the procedure was observed. Adherence to national guidelines regarding the use of anesthesia providers for low-risk patients was poor.

Conclusion

A difference in outcome associated with the presence or absence of an anesthesia provider during screening colonoscopy in terms of MI, stroke, or hospital admission within 7 days of the procedure was not observed. Adherence to published guidelines for the use of anesthesia providers is low. The incidence of completed exams was unaffected by the presence of an anesthesia provider. However, a nonstatistically significant trend toward increased cancer detection requires further study.

Keywords:

• safety
• complications
• myocardial infarction
• stroke
• endoscopy
• anesthesiology

Supplementary table

Table

Acknowledgments

We would like to thank Valerie A Arkoosh, MD, MPH, of the University of Pennsylvania – Department of Anesthesiology for her assistance with this project. We would also like to thank Ms Garla Connor and Miss Krystie Cabrales for their assistance with manuscript preparation.

Author contributions

All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work.

Disclosure

Qianli Ma and Claudia Uribe are employed by Humana. John Hanna was employed by Humana at the time the project was conducted. The other authors report no conflicts of interest in this work.