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Complication rates after endoscopies higher than reported

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – About 1% of outpatient endoscopies require a subsequent visit to the emergency room for related complications, but fewer than a quarter of these cases are noted in standard reporting procedures, according to findings published in the Archives of Internal Medicine for October 25.

Furthermore, these complications incur significant charges, and represent a hidden cost of screening programs, the authors point out.

Dr. Daniel A. Leffler with Beth Israel Deaconess Medical Center in Boston, Massachusetts, and colleagues used the Center’s electronic medical record system to track patients’ visits to the emergency department within 14 days after they had undergone an outpatient endoscopy.

The study included 6383 upper endoscopies and 11,632 colonoscopies, and the tracking system identified 419 patients who were seen in the emergency department after undergoing these procedures. Physician reviewers found that 134 of these visits were related to the procedure, and 76 of them resulted in hospitalization.

During the study period, only 31 endoscopy-related complications resulting in an emergency department visit or hospitalization were noted through the voluntary physician reporting system.

Overall, 0.79% of all outpatient endoscopies led to a hospital visit for complications, at a mean of 5-6 days after the procedure, the team found. “The most common reasons for these visits were abdominal pain (47%), GI tract bleeding (12%), and chest pain (11%), which together accounted for more than half of ED visits,” according to the report.

The average cost was $6356 per hospital visit, the researchers note. For colonoscopy screening or surveillance programs, the costs of complications represent an additional $48 per examination.

“Although on an individual basis this cost is relatively low, projected nationwide, this is a considerable and underreported cost to the medical system, which could exceed $650 million per year in the United States,” the authors point out.

Strategies for automating adverse event reporting should be developed, they suggest.

“Although the overall rate of severe complications, including perforation, myocardial infarction, and death remained low, the true range of adverse events is much greater than typically appreciated, and the overall rate of 1 in 127 patients visiting the hospital due to an outpatient endoscopic procedure is a cause for concern,” Dr. Leffler and colleagues conclude.

Arch Intern Med 2010;170:1752-1757.