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Risks, time trends, and mortality of colonoscopy‐induced perforation in hospitalized patients
Author(s) -
Garg Rajat,
Singh Amandeep,
Ahuja Keerat R,
Mohan Babu P,
Ravi Shri J K,
Shen Bo,
Kirby Donald F,
Regueiro Miguel
Publication year - 2020
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14996
Subject(s) - medicine , colonoscopy , perforation , odds ratio , incidence (geometry) , multivariate analysis , polypectomy , univariate analysis , gastroenterology , retrospective cohort study , surgery , colorectal cancer , cancer , materials science , physics , optics , punching , metallurgy
Background and Aim Colonic perforation is a rare complication of colonoscopy and ranges from 0% to 1% in all patients undergoing colonoscopy. The aim of this study was to assess the time trends, risk factors, and mortality associated with colonoscopy‐induced perforation (CIP) in hospitalized patients as the data are limited. Methods Data are obtained from the Nationwide Inpatient Sample database to identify hospitalized patients between 2005 and 2014 that had CIP. Various factors like age and gender were assessed for association with CIP, followed by univariate and multivariate regression analyses. Results A total of 2 651 109 patients underwent inpatient colonoscopy between 2005 and 2014, and 4567 (0.2%) of the patients had CIP. Overall, incidence of CIP has increased from 2005 to 2014 (0.1% to 0.3%) ( P < 0.001). On multivariate analysis, the adjusted odds ratio (OR) for CIP was highest in Caucasian race (OR: 1.49 [1.09, 2.06]), followed by after polypectomy, history of inflammatory bowel disease, end‐stage renal disease, and age > 65 years (OR [95% CI] of 1.35 [1.23, 1.47], 1.34 [1.17, 1.53], 1.28 [1.02, 1.62], and 1.21 [1.11, 1.33], respectively) (all P < 0.05). CIP group had 33% less obesity (OR [95% CI]: 0.77 [0.65–0.9], P = 0.002) and 13‐fold higher mortality (0.5% vs 8.1%) ( P < 0.001) as compared to patients without CIP. The CIP‐associated mortality ranged from 2% to 8% and remained stable throughout the study period. Conclusions Our study suggests that the risk of CIP was highest in elderly patients, Caucasians, those with inflammatory bowel disease, end‐stage renal disease, and after polypectomy. Recognizing the factors associated with CIP may lead to informed discussion about risks and benefits of inpatient colonoscopy.