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Incidence of and Risk Factors for Systemic Adverse Events After Screening or Primary Diagnostic Colonoscopy: A Nationwide Cohort Study
- Source :
- American Journal of Gastroenterology. 115:537-547
- Publication Year :
- 2020
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2020.
-
Abstract
- Objectives To estimate the systemic serious adverse event (SAE) rates after colonoscopy and to identify their risk factors. Methods A nationwide cohort study was conducted using the comprehensive French claims databases SNDS (National Health Data System). Patients aged 30 years and over who underwent a first screening or diagnostic colonoscopy in 2010-2015 were included. The rates of cardiovascular and renal SAEs were estimated within 5 days after colonoscopy. The standardized incidence ratios were calculated to compare these incidence rates with those of the same events in the general population, and the associated risk factors were assessed by multilevel logistic regression. Results Among the 4,088,799 included patients (median age, 59 years [interquartile range = 50-67]; 55.2% women; 30.1% with a Charlson index score ≤1), the 5-day SAE incidence rate was 2.8/10,000 procedures for shock, 0.87/10,000 for myocardial infarction, 1.9/10,000 for stroke, 2.9/10,000 for pulmonary embolism, 5.5/10,000 for acute renal failure, and 3.3/10,000 for urolithiasis. These SAEs occurred 3.3 to 15.8 times more often during the first 5 days after colonoscopy than expected in the general population. Thirty-day mortality rates ranged from 2.2/1,000 cases of urolithiasis to 268.1/1,000 cases of shock. Increasing age was associated with an increasing incidence of SAEs. Risks of shock and acute renal failure were associated with a greater number of comorbidities than the other SAEs. Colonoscopies in university hospitals were associated with higher risks, reflecting patient selection processes. Discussion The systemic SAEs can be associated with a substantial mortality. They should be taken into account when deciding colonoscopy, in addition to perforation and bleeding, particularly in elderly patients with multiple comorbidities.
- Subjects :
- Adult
Male
medicine.medical_specialty
Population
Perforation (oil well)
Colonoscopy
Comorbidity
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Risk Factors
Interquartile range
Internal medicine
medicine
Humans
Mass Screening
education
Mass screening
Aged
education.field_of_study
Hepatology
medicine.diagnostic_test
business.industry
Incidence
Incidence (epidemiology)
Mortality rate
Gastroenterology
Middle Aged
030220 oncology & carcinogenesis
Female
030211 gastroenterology & hepatology
France
business
Cohort study
Subjects
Details
- ISSN :
- 15720241 and 00029270
- Volume :
- 115
- Database :
- OpenAIRE
- Journal :
- American Journal of Gastroenterology
- Accession number :
- edsair.doi.dedup.....b97c1fe13b791eb19f3c6665823b79cd