A national study of cardiopulmonary unplanned events after GI endoscopy{A figure is presented}

Virender K. Sharma, Cuong C. Nguyen, Michael D. Crowell, David Lieberman, Patricia de Garmo, David E. Fleischer

Research output: Contribution to journalArticle

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Abstract

Background: Cardiopulmonary unplanned events (CUE) related to conscious sedation constitute a major proportion of GI endoscopy-associated complications. Objectives: Our purpose was to study the incidence of CUE during GI endoscopy and to determine factors that may predict CUE. Design: Retrospective CORI (Clinical Outcomes Research Initiative) database review. Patients: Undergoing GI endoscopy under conscious sedation. Main Outcome Measurement: CUE associated with GI endoscopy. Results: Data on 324,737 unique procedures (EGD, 140,692; colonoscopy, 174,255; ERCP, 6092; and EUS, 3698) performed with the patient under conscious sedation were analyzed. Unplanned events were reported in 1.4% of procedures; 0.9% were associated with CUE. Rates of CUE with EGD, colonoscopy, ERCP, and EUS were 0.6%, 1.1%, 2.1%, and 0.9%, respectively. Multiple logistic regression revealed patient age (odds ratio [OR] 1.02, 95% CI 1.01-1.02) and ASA class were significant predictors of CUE (OR compared with ASA I: ASA II 1.05, 95% CI 0.95-1.16; ASA III 1.8, 95% CI 1.6-2.0, ASA IV 3.2, 95% CI 2.5-4.1, ASA V 7.5; 95% CI 3.2-17.6). Inpatient procedures were associated with higher CUE (OR 1.5, 95% CI 1.3-1.7). Compared with universities, nonuniversity sites (OR 1.2, 95% CI 1.1-1.4) and Veterans Administration Medical Centers (OR 1.4, 95% CI 1.2-1.5) had significantly higher CUE. Use of supplemental oxygen during a procedure was associated with significantly more CUE (OR 1.2, 95% CI 1.1-1.3). Involvement of a trainee with a procedure was also associated with higher CUE (OR 1.3, 95% CI 1.1-1.4). Limitations: Retrospective review of data entered voluntarily by endoscopists not trained on CORI data entry. Conclusions: During GI endoscopy with conscious sedation, patient's age, higher ASA grade, inpatient status, trainee participation, and routine use of oxygen are associated with a higher incidence of CUE.

Original languageEnglish (US)
Pages (from-to)27-34
Number of pages8
JournalGastrointestinal Endoscopy
Volume66
Issue number1
DOIs
StatePublished - Jul 2007
Externally publishedYes

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Endoscopy
Conscious Sedation
Odds Ratio
Endoscopic Retrograde Cholangiopancreatography
Colonoscopy
Inpatients
Outcome Assessment (Health Care)
Oxygen
United States Department of Veterans Affairs
Cohort Studies
Logistic Models
Databases
Incidence

ASJC Scopus subject areas

  • Gastroenterology

Cite this

A national study of cardiopulmonary unplanned events after GI endoscopy{A figure is presented}. / Sharma, Virender K.; Nguyen, Cuong C.; Crowell, Michael D.; Lieberman, David; de Garmo, Patricia; Fleischer, David E.

In: Gastrointestinal Endoscopy, Vol. 66, No. 1, 07.2007, p. 27-34.

Research output: Contribution to journalArticle

Sharma, Virender K. ; Nguyen, Cuong C. ; Crowell, Michael D. ; Lieberman, David ; de Garmo, Patricia ; Fleischer, David E. / A national study of cardiopulmonary unplanned events after GI endoscopy{A figure is presented}. In: Gastrointestinal Endoscopy. 2007 ; Vol. 66, No. 1. pp. 27-34.
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abstract = "Background: Cardiopulmonary unplanned events (CUE) related to conscious sedation constitute a major proportion of GI endoscopy-associated complications. Objectives: Our purpose was to study the incidence of CUE during GI endoscopy and to determine factors that may predict CUE. Design: Retrospective CORI (Clinical Outcomes Research Initiative) database review. Patients: Undergoing GI endoscopy under conscious sedation. Main Outcome Measurement: CUE associated with GI endoscopy. Results: Data on 324,737 unique procedures (EGD, 140,692; colonoscopy, 174,255; ERCP, 6092; and EUS, 3698) performed with the patient under conscious sedation were analyzed. Unplanned events were reported in 1.4{\%} of procedures; 0.9{\%} were associated with CUE. Rates of CUE with EGD, colonoscopy, ERCP, and EUS were 0.6{\%}, 1.1{\%}, 2.1{\%}, and 0.9{\%}, respectively. Multiple logistic regression revealed patient age (odds ratio [OR] 1.02, 95{\%} CI 1.01-1.02) and ASA class were significant predictors of CUE (OR compared with ASA I: ASA II 1.05, 95{\%} CI 0.95-1.16; ASA III 1.8, 95{\%} CI 1.6-2.0, ASA IV 3.2, 95{\%} CI 2.5-4.1, ASA V 7.5; 95{\%} CI 3.2-17.6). Inpatient procedures were associated with higher CUE (OR 1.5, 95{\%} CI 1.3-1.7). Compared with universities, nonuniversity sites (OR 1.2, 95{\%} CI 1.1-1.4) and Veterans Administration Medical Centers (OR 1.4, 95{\%} CI 1.2-1.5) had significantly higher CUE. Use of supplemental oxygen during a procedure was associated with significantly more CUE (OR 1.2, 95{\%} CI 1.1-1.3). Involvement of a trainee with a procedure was also associated with higher CUE (OR 1.3, 95{\%} CI 1.1-1.4). Limitations: Retrospective review of data entered voluntarily by endoscopists not trained on CORI data entry. Conclusions: During GI endoscopy with conscious sedation, patient's age, higher ASA grade, inpatient status, trainee participation, and routine use of oxygen are associated with a higher incidence of CUE.",
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AU - Sharma, Virender K.

AU - Nguyen, Cuong C.

AU - Crowell, Michael D.

AU - Lieberman, David

AU - de Garmo, Patricia

AU - Fleischer, David E.

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N2 - Background: Cardiopulmonary unplanned events (CUE) related to conscious sedation constitute a major proportion of GI endoscopy-associated complications. Objectives: Our purpose was to study the incidence of CUE during GI endoscopy and to determine factors that may predict CUE. Design: Retrospective CORI (Clinical Outcomes Research Initiative) database review. Patients: Undergoing GI endoscopy under conscious sedation. Main Outcome Measurement: CUE associated with GI endoscopy. Results: Data on 324,737 unique procedures (EGD, 140,692; colonoscopy, 174,255; ERCP, 6092; and EUS, 3698) performed with the patient under conscious sedation were analyzed. Unplanned events were reported in 1.4% of procedures; 0.9% were associated with CUE. Rates of CUE with EGD, colonoscopy, ERCP, and EUS were 0.6%, 1.1%, 2.1%, and 0.9%, respectively. Multiple logistic regression revealed patient age (odds ratio [OR] 1.02, 95% CI 1.01-1.02) and ASA class were significant predictors of CUE (OR compared with ASA I: ASA II 1.05, 95% CI 0.95-1.16; ASA III 1.8, 95% CI 1.6-2.0, ASA IV 3.2, 95% CI 2.5-4.1, ASA V 7.5; 95% CI 3.2-17.6). Inpatient procedures were associated with higher CUE (OR 1.5, 95% CI 1.3-1.7). Compared with universities, nonuniversity sites (OR 1.2, 95% CI 1.1-1.4) and Veterans Administration Medical Centers (OR 1.4, 95% CI 1.2-1.5) had significantly higher CUE. Use of supplemental oxygen during a procedure was associated with significantly more CUE (OR 1.2, 95% CI 1.1-1.3). Involvement of a trainee with a procedure was also associated with higher CUE (OR 1.3, 95% CI 1.1-1.4). Limitations: Retrospective review of data entered voluntarily by endoscopists not trained on CORI data entry. Conclusions: During GI endoscopy with conscious sedation, patient's age, higher ASA grade, inpatient status, trainee participation, and routine use of oxygen are associated with a higher incidence of CUE.

AB - Background: Cardiopulmonary unplanned events (CUE) related to conscious sedation constitute a major proportion of GI endoscopy-associated complications. Objectives: Our purpose was to study the incidence of CUE during GI endoscopy and to determine factors that may predict CUE. Design: Retrospective CORI (Clinical Outcomes Research Initiative) database review. Patients: Undergoing GI endoscopy under conscious sedation. Main Outcome Measurement: CUE associated with GI endoscopy. Results: Data on 324,737 unique procedures (EGD, 140,692; colonoscopy, 174,255; ERCP, 6092; and EUS, 3698) performed with the patient under conscious sedation were analyzed. Unplanned events were reported in 1.4% of procedures; 0.9% were associated with CUE. Rates of CUE with EGD, colonoscopy, ERCP, and EUS were 0.6%, 1.1%, 2.1%, and 0.9%, respectively. Multiple logistic regression revealed patient age (odds ratio [OR] 1.02, 95% CI 1.01-1.02) and ASA class were significant predictors of CUE (OR compared with ASA I: ASA II 1.05, 95% CI 0.95-1.16; ASA III 1.8, 95% CI 1.6-2.0, ASA IV 3.2, 95% CI 2.5-4.1, ASA V 7.5; 95% CI 3.2-17.6). Inpatient procedures were associated with higher CUE (OR 1.5, 95% CI 1.3-1.7). Compared with universities, nonuniversity sites (OR 1.2, 95% CI 1.1-1.4) and Veterans Administration Medical Centers (OR 1.4, 95% CI 1.2-1.5) had significantly higher CUE. Use of supplemental oxygen during a procedure was associated with significantly more CUE (OR 1.2, 95% CI 1.1-1.3). Involvement of a trainee with a procedure was also associated with higher CUE (OR 1.3, 95% CI 1.1-1.4). Limitations: Retrospective review of data entered voluntarily by endoscopists not trained on CORI data entry. Conclusions: During GI endoscopy with conscious sedation, patient's age, higher ASA grade, inpatient status, trainee participation, and routine use of oxygen are associated with a higher incidence of CUE.

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