Anesthesia Experts

Scope-Related Infections

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Authors: Wang P et al. 

Gut 2018 May 18

Postprocedure infections are not unusual after colonoscopy or esophagogastroduodenoscopy.

Although concerns have been raised regarding bleeding and perforation with endoscopic procedures, little attention has been given to the risk for infection after colonoscopy and esophagogastroduodenoscopy (EGD). To estimate the rate of infections following these procedures, researchers analyzed all-payer information for 2014 from six diverse states to estimate infection-related unplanned visits following colonoscopies and EGDs as well as three control procedures (screening mammography, cystoscopy, and bronchoscopy) performed in ambulatory surgical centers.

The 7-day postprocedure infection rates per 1000 procedures were 1.1 for screening colonoscopy, 1.6 for nonscreening colonoscopy, 3.0 for EGD, 16.5 for bronchoscopy, and 4.4 for cystoscopy, compared with 0.6 for screening mammography. The 30-day infection rates were 4.0 for screening colonoscopy, 5.4 for nonscreening colonoscopy, 10.8 for EGD, and 2.9 for screening mammography.

Rates of septicemia and gastrointestinal, respiratory, and genitourinary infections were all higher after colonoscopy or EGD than after screening mammography and were generally similar for procedures performed with or without general anesthesia. Advanced age, prior hospitalization within 30 days, or a prior gastrointestinal procedure within 30 days were all risk factors for infection after colonoscopy or EGD. Infection rates varied markedly among ambulatory surgical centers; rates were higher (up to 132 per 1000 nonscreening colonoscopies) in low-volume facilities (<10 procedures per year).

COMMENT

A retrospective analysis based on claims data has obvious limitations. However, this work highlights an unappreciated infection risk associated with colonoscopy and EGD procedures (as well as with bronchoscopy and cystoscopy). Of further concern is the marked variation in infection rates by facility, given that ambulatory surgical centers may not necessarily be aware of infection rates as patients are likely seen for follow-up at other institutions. These issues require further attention.

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