Risk factors for suspected infectious fever after diagnostic upper endoscopy: propofol overdose in a retrospective study from Korea.

Background: Propofol is widely used for sedation during upper endoscopy; however, oversedation may increase the risk of complications, including aspiration pneumonia. This study aimed to determine whether propofol overdose is a risk factor for suspected postendoscopic infectious fever (SPIF).

Methods: We retrospectively analyzed 1,474 in-patients who underwent upper endoscopy at Inha University Hospital between October 2021 and October 2022. After excluding 400 patients who received interventional procedures, SPIF was defined as new-onset fever (≥38 °C) within three days post-endoscopy with at least one of the following: intravenous antibiotic initiation, leukocytosis (white blood cell≥10,000/mm³), positive blood or sputum cultures, or pneumonia on chest X-ray. The risk factors assessed included comorbidities, sedative type and dosage, procedure duration, and endoscopist's experience.

Results: New-onset fever occurred in 40 patients (3.7%), with 20 (1.9%) meeting SPIF criteria. Multivariable analysis showed propofol overdose (>2.2 mg/kg) significantly increased risks of new-onset fever (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.00-1.06; p=0.023) and SPIF (OR, 1.04; 95% CI, 1.00-1.04; p=0.034). Dementia (OR, 1.11, p<0.001) and prolonged procedure (>5 minutes; OR, 1.01; p=0.012) were also risk factors for SPIF.

Conclusions: Propofol overdose significantly increases the risk of SPIF. Careful sedation management is essential, especially for patients with dementia or prolonged procedures.