Department of Gastroenterology, Eastern Virginia Medical School, Norfolk, Virginia.
Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon.
Clin Gastroenterol Hepatol. 2017 Jun;15(6):883-891.e9. doi: 10.1016/j.cgh.2016.12.015. Epub 2016 Dec 23.
BACKGROUND & AIMS: The incidence and predictors of non-gastrointestinal (GI) adverse events (AEs) after colonoscopy are not well-understood. We studied the effects of antithrombotic agents, cardiopulmonary comorbidities, and age on risk of non-GI AEs after colonoscopy.
We performed a retrospective longitudinal analysis to assess the diagnosis, procedure, and prescription drug codes in a United States commercial claims database (March 2010-March 2012). Data from patients at increased risk (n = 82,025; defined as patients with pulmonary comorbidities or cardiovascular disease requiring antithrombotic medications) were compared with data from 398,663 average-risk patients. In a 1:1 matched analysis, 51,932 patients at increased risk, examined by colonoscopy, were compared with 51,932 matched (on the basis of age, sex, and comorbidities) patients at increased risk who did not undergo colonoscopy. We tracked cardiac, pulmonary, and neurovascular events 1-30 days after colonoscopy.
Thirty days after outpatient colonoscopy, non-GI AEs were significantly higher in patients taking antithrombotic medications (7.3%; odds ratio [OR], 10.75; 95% confidence interval, 10.13-11.42) or those with pulmonary comorbidities (1.8%; OR, 2.44; 95% confidence interval, 2.27-2.62) vs average-risk patients (0.7%) and in patients 60-69 years old (OR, 2.21; 95% confidence interval, 2.01-2.42) or 70 years or older (OR, 6.45; 95% confidence interval, 5.89-7.06), compared with patients younger than 50 years. The 30-day incidence of non-GI AEs in patients at increased risk who underwent colonoscopy was also significantly higher than in matched patients at increased risk who did not undergo colonoscopy in the anticoagulant group (OR, 2.31; 95% confidence interval, 2.01-2.65) and in the chronic obstructive pulmonary disease group (OR, 1.33; 95% confidence interval, 1.13-1.56).
Increased number of comorbidities and older age (older than 60 years) are associated with increased risk of non-GI AEs after colonoscopy. These findings indicate the importance of determining comorbid risk and evaluating antithrombotic management before colonoscopy.
目前尚不清楚结肠镜检查后非胃肠道（GI）不良事件（AE）的发生率和预测因素。我们研究了抗血栓药物、心肺合并症和年龄对结肠镜检查后非 GI AE 风险的影响。
我们进行了一项回顾性纵向分析，以评估美国商业索赔数据库（2010 年 3 月至 2012 年 3 月）中的诊断、程序和处方药物代码。将高危患者（n=82025 例；定义为患有肺部合并症或心血管疾病需要抗血栓药物治疗的患者）的数据与 398663 例普通风险患者的数据进行比较。在 1:1 匹配分析中，将 82025 例高危患者（基于年龄、性别和合并症）中接受结肠镜检查的患者与 51932 例高危但未接受结肠镜检查的匹配患者（基于年龄、性别和合并症）进行比较。我们在结肠镜检查后 1-30 天内跟踪心脏、肺部和神经血管事件。
在门诊结肠镜检查后 30 天，服用抗血栓药物的患者（7.3%；比值比[OR]，10.75；95%置信区间，10.13-11.42）或患有肺部合并症的患者（1.8%；OR，2.44；95%置信区间，2.27-2.62）与普通风险患者（0.7%）和 60-69 岁的患者（OR，2.21；95%置信区间，2.01-2.42）或 70 岁或以上的患者（OR，6.45；95%置信区间，5.89-7.06）相比，非 GI AE 的发生率显著更高。在接受结肠镜检查的高危患者中，非 GI AE 的 30 天发生率也显著高于未接受结肠镜检查的高危匹配患者，在抗凝组（OR，2.31；95%置信区间，2.01-2.65）和慢性阻塞性肺疾病组（OR，1.33；95%置信区间，1.13-1.56）中也是如此。
合并症数量增加和年龄较大（60 岁以上）与结肠镜检查后非 GI AE 风险增加相关。这些发现表明，在结肠镜检查前确定合并症风险和评估抗血栓药物管理非常重要。
