Anaesthesia care for emergency endoscopy for peptic ulcer bleeding. A nationwide population-based cohort study

ABSTRACT

Objective: Currently, no standard approach exists to the level of monitoring or presence of staff with anaesthetic expertise required during emergency esophago-gastro-duodenoscopy (EGD) for peptic ulcer bleeding (PUB). We assess the association between anaesthesia care and mortality. We further describe the prevalence and inter-hospital variation of anaesthesia care in Denmark and identify clinical predictors for choosing anaesthesia care. Material and methods: This population-based cohort study included all emergency EGDs for PUB in adults during 2012–2013. About 90-day all-cause mortality after EGD was estimated by crude and adjusted logistic regression. Clinical predictors of anaesthesia care were identified in another logistic regression model. Results: Some 3.056 EGDs performed at 21 hospitals were included; 2074 (68%) received anaesthesia care and 982 (32%) were managed under supervison of the endoscopist. Some 16.7% of the patients undergoing EGD with anaesthesia care died within 90 days after the procedure, compared to 9.8% of the patients who had no anaesthesia care, adjusted OR = 1.51 (95% CI = 1.25–1.83). Comparing the two hospitals with the most frequent (98.6% of al EGDs) and least frequent (6.9%) use of anaesthesia care, mortality was 13.7% and 11.7%, respectively, adjusted OR = 1.22 (95% CI = 0.55–2.71). The prevalence of anaesthesia care varied between the hospitals, median = 78.9% (range 6.9–98.6%). Predictors of choosing anaesthesia care were shock at admission, high ASA score, and no pre-existing comorbidity. Conclusions: Use of anaesthesia care for emergency EGD was associated with increased mortality, most likely because of confounding by indication. The use of anaesthesia care varied greatly between hospitals, but was unrelated to mortality at hospital level.

Keywords:

• Anaesthesia care
• cohort study
• endoscopy
• peptic ulcer bleeding

Acknowledgements

We acknowledge the contribution to the study design by Dr Therese Risom Vestergaard and Dr Martin Risom.

Disclosure statement

The authors declare no conflicts of interest. None of the authors have relationships with funds or companies that might have an interest in the submitted work in the previous 5 years. Their spouses, partners, or children have no financial relationships that may be relevant to the submitted work. None of the authors have any non-financial interests that may be relevant to the submitted work. This work was supported by Karner’s Foundation, Denmark. The study was further supported by Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Hvidovre. S.J.R. received support from Oda and Hans Svenningsen’s Foundation and the Heede Nielsen Family Foundation. The funding had no role of the study design or impact on the draughting of the article.