Background & Aims
Despite the increased use of anesthesia services for endoscopic procedures in the United States, the risks of anesthesia-directed sedation (ADS) are unclear. We analyzed national data from multiple centers to determine patterns of use of anesthesia services and risk factors for serious complications.
We performed a cross-sectional study using the National Anesthesia Clinical Outcomes Registry, a national quality improvement database. Univariable and bivariate analyses investigated frequencies and relationships between pre-defined variables and serious complications of anesthesia (cardiovascular, respiratory, neurologic, drug-related, patient injury, death, or unexpected admission). A multivariable mixed effects model determined odds ratios between these variables and serious complications, adjusting for confounders and varying reporting practices.
In total, 428,947 endoscopic procedures of adults were performed using ADS from 2010 from 2015. The population was 54.9% female with a mean age of 59.1 years and predominantly American Society of Anesthesiologists class 2/3 (74.4%). More than half of the procedures were colonoscopies (51.4%); 37.4% were esophagogastroduodenoscopies and 6.5% were endoscopic retrograde cholangiopancreatographies. A total of 4441 complications (1.09%) were reported; 1349 were serious complications (0.34%). In multivariable analysis, older age, American Society of Anesthesiologists class 4/5, esophagogastroduodenoscopy, general anesthesia, endoscopists on an overnight shift, and longer cases were independently and significantly associated with serious complications.
In an analysis of data from the National Anesthesia Clinical Outcomes Registry, we found ADS during endoscopy to be safe, with few serious complications (<1% of procedures). Risk of ADS complications increased with older age, more severe disease, procedure type, and case complexity.