Pre-endoscopy Anesthesiology Clinic Evaluation Does Not Reduce Adverse Event Rates for High-risk for Sedation Patients.

Abstract

Objectives: Preoperative or preanesthesia evaluation is an established practice in patients undergoing surgery. The efficacy of a similar practice before endoscopic procedures has not yet been determined. At our medical center, patients with severe comorbidities, deemed at high risk for sedation, were assigned to an anesthesiologist-supervised endoscopic procedure (ASEP). Since late 2016 they are assessed at anesthesiology clinic pre-endoscopy. Our objective was to compare adverse events (AEs) between these 2 strategies.

Methods: A retrospective review of all ambulatory upper and lower endoscopies between 2016 and 2017 was performed. Data on postprocedural (14 d) emergency department (ED) admissions, hospitalizations, operations, and mortality before and after policy change (BPC and APC) were compared.

Results: During the study period 18,240 ambulatory upper and lower endoscopic procedures were performed in 14,906 patients, 7447 (49.96%) BPC, and 7459 (50.04%) APC; 580 were ASEP. The proportions of ASEP were comparable between the 2 time periods (BPC 295 versus APC 285; P=0.721); however, APC there was a 25-fold increase in pre-endoscopy anesthesiology clinic assessments [BPC-6 patients (2.03%) versus APC-146 patients (51.22%), P<0.001]. Postprocedural sedation-related AEs were comparable between the groups [0.07%-BPC (head injury, stroke, myocardial infarction, and aspiration) versus 0.03%-APC (aspiration and dyspnea), P=0.256]. None of these patients were sedated by an anesthesiologist.

Conclusions: Policy change of pre-endoscopy evaluation for high-risk for sedation patients was not associated with a change in AE rates. Policy adherence was limited. The lack of AE rate reduction may indicate a marginal impact on an already low event rate with ASEP for high-risk patients.