Pierre-Olivier Blotière1, Alain Weill2, Philippe Ricordeau2, François Alla3, Hubert Allemand3. 1. Strategy and Research Department, National Health Insurance (CNAMTS), 50, avenue du Pr-André-Lemierre, 75986 Paris cedex 20, France. Electronic address: pierre-olivier.blotiere@cnamts.fr. 2. Strategy and Research Department, National Health Insurance (CNAMTS), 50, avenue du Pr-André-Lemierre, 75986 Paris cedex 20, France. 3. General Division, National Health Insurance (CNAMTS), 50, avenue du Pr-André-Lemierre, 75986 Paris cedex 20, France.
Abstract
BACKGROUND AND OBJECTIVE: To estimate the perforation and haemorrhage rate after colonoscopy in the French population in 2010 and to identify risk factors for these complications. METHOD: Study based on SNIIRAM and the PMSI databases. Patients treated for IBD or colorectal cancer were excluded. Two types of complications were investigated: perforation and haemorrhage. OR adjusted for patient (gender, age, chronic disease) and colonoscopy (polypectomy, emergency) characteristics were calculated by using a logistic regression model. RESULTS: The cohort was composed of 947,061 individuals. The estimated perforation rate was between 4.5 and 9.7 per 10,000 procedures and the estimated haemorrhage rate was between 9.9 and 11.0 per 10,000 procedures. The main risk factors associated with perforation and haemorrhage were the patient's age (over 80 years compared to under 40, OR=7.51 and 3.23), resection of polyps larger than 1 cm or more than 4 polyps (compared to no polypectomy, OR=2.72 and 5.12) and emergency colonoscopy (OR=4.63 and 5.99). Colonoscopy performed by a gastroenterologist performing less than 244 colonoscopies per year was associated with an increased risk of perforation (OR=2.29). Complication rates were higher in institutions performing less than 510 colonoscopies per year, but this was no longer the case after adjustment for emergency colonoscopies. CONCLUSIONS: This study, which includes nearly one million colonoscopies, suggests taking the gastroenterologist's number of colonoscopies into account to ensure optimal organization of the management of very elderly patients requiring colonoscopy.
BACKGROUND AND OBJECTIVE: To estimate the perforation and haemorrhage rate after colonoscopy in the French population in 2010 and to identify risk factors for these complications. METHOD: Study based on SNIIRAM and the PMSI databases. Patients treated for IBD or colorectal cancer were excluded. Two types of complications were investigated: perforation and haemorrhage. OR adjusted for patient (gender, age, chronic disease) and colonoscopy (polypectomy, emergency) characteristics were calculated by using a logistic regression model. RESULTS: The cohort was composed of 947,061 individuals. The estimated perforation rate was between 4.5 and 9.7 per 10,000 procedures and the estimated haemorrhage rate was between 9.9 and 11.0 per 10,000 procedures. The main risk factors associated with perforation and haemorrhage were the patient's age (over 80 years compared to under 40, OR=7.51 and 3.23), resection of polyps larger than 1 cm or more than 4 polyps (compared to no polypectomy, OR=2.72 and 5.12) and emergency colonoscopy (OR=4.63 and 5.99). Colonoscopy performed by a gastroenterologist performing less than 244 colonoscopies per year was associated with an increased risk of perforation (OR=2.29). Complication rates were higher in institutions performing less than 510 colonoscopies per year, but this was no longer the case after adjustment for emergency colonoscopies. CONCLUSIONS: This study, which includes nearly one million colonoscopies, suggests taking the gastroenterologist's number of colonoscopies into account to ensure optimal organization of the management of very elderly patients requiring colonoscopy.
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Authors: Nicola de'Angelis; Salomone Di Saverio; Osvaldo Chiara; Massimo Sartelli; Aleix Martínez-Pérez; Franca Patrizi; Dieter G Weber; Luca Ansaloni; Walter Biffl; Offir Ben-Ishay; Miklosh Bala; Francesco Brunetti; Federica Gaiani; Solafah Abdalla; Aurelien Amiot; Hany Bahouth; Giorgio Bianchi; Daniel Casanova; Federico Coccolini; Raul Coimbra; Gian Luigi de'Angelis; Belinda De Simone; Gustavo P Fraga; Pietro Genova; Rao Ivatury; Jeffry L Kashuk; Andrew W Kirkpatrick; Yann Le Baleur; Fernando Machado; Gustavo M Machain; Ronald V Maier; Alain Chichom-Mefire; Riccardo Memeo; Carlos Mesquita; Juan Carlos Salamea Molina; Massimiliano Mutignani; Ramiro Manzano-Núñez; Carlos Ordoñez; Andrew B Peitzman; Bruno M Pereira; Edoardo Picetti; Michele Pisano; Juan Carlos Puyana; Sandro Rizoli; Mohammed Siddiqui; Iradj Sobhani; Richard P Ten Broek; Luigi Zorcolo; Maria Clotilde Carra; Yoram Kluger; Fausto Catena Journal: World J Emerg Surg Date: 2018-01-24 Impact factor: 5.469