Gastroenterology

Gastroenterology

Volume 135, Issue 6, December 2008, Pages 1899-1906.e1
Gastroenterology

Clinical—Alimentary Tract
Bleeding and Perforation After Outpatient Colonoscopy and Their Risk Factors in Usual Clinical Practice

https://doi.org/10.1053/j.gastro.2008.08.058Get rights and content

Background & Aims

The most widely quoted complication rates for colonoscopy are from case series performed by expert endoscopists. Our objectives were to evaluate the rates of bleeding, perforation, and death associated with outpatient colonoscopy and their risk factors in a population-based study.

Methods

We identified all individuals 50 to 75 years old who underwent an outpatient colonoscopy during April 1, 2002, to March 31, 2003, in British Columbia, Alberta, Ontario, and Nova Scotia, Canada. Using administrative data, we identified all individuals who were admitted to hospital with bleeding or perforation within 30 days following the colonoscopy in each province. We calculated the pooled rates of bleeding and perforation from the 4 provinces. In Ontario, we abstracted the hospital charts of all deaths that occurred within 30 days following the procedure. We used generalized estimating equations models to evaluate factors associated with bleeding and perforation.

Results

We identified 97,091 persons who had an outpatient colonoscopy. The pooled rates of colonoscopy-related bleeding and perforation were 1.64/1000 and 0.85/1000, respectively. The death rate was 0.074/1000 or approximately 1/14,000. Older age, male sex, having a polypectomy, and having the colonoscopy performed by a low-volume endoscopist were associated with increased odds of bleeding or perforation.

Conclusions

Although colonoscopy has established benefits for the detection of colorectal cancer and adenomatous polyps, the procedure is associated with risks of serious complications, including death. Older age, male sex, having a polypectomy, and having the procedure done by a low-volume endoscopist were independently associated with colonoscopy-related bleeding and perforation.

Section snippets

Study Design

The study is a population-based cohort of persons who underwent outpatient colonoscopy in 4 Canadian provinces (British Columbia, Alberta, Ontario, Nova Scotia) during April 1, 2002, to March 31, 2003.

Administrative Data Sources

Data were obtained from the Canadian Institute for Health Information (CIHI) Discharge Abstract Database, which contains information on every patient discharged from a hospital or same-day surgery unit since 1988 and includes patient demographics, major diagnoses, procedures, and discharge status.

Study Cohort

Between April 1, 2002, and March 31, 2003, we identified 97,091 persons age 50 to 75 years who had an outpatient colonoscopy (Table 1). Ontario had the largest number of colonoscopies (67,632; 69.7%), followed by British Columbia (13,999; 14.4%), Alberta (11,054; 11.4%), and Nova Scotia (4,406; 4.5%). The mean age of the cohort was 60.9 years, 52,641 (54.2%) were women, and 23,623 (24.3%) had a polypectomy performed during the procedure.

Table 2 summarizes the characteristics of the study

Discussion

We report here that the rates of bleeding and perforation requiring hospitalization within 30 days following outpatient colonoscopy are 1.64/1000 and 0.85/1000, respectively, in usual clinical practice. This perforation rate is within the target of ≤1/1000 for all colonoscopies set by the US Multi-Society Task Force on Colorectal Cancer.6 We also report here a risk of death of 0.074/1000 or approximately 1/14,000 from outpatient colonoscopy. The patient factors associated with

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The authors disclose the following: Supported by Canadian Institutes of Health Research (CIHR).

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