Mandarino Francesco Vito, Gribaudo Giorgia, Salmeri Noemi, Fanti Lorella, Barchi Alberto, Massimino Luca, Fasulo Ernesto, Dell'Anna Giuseppe, Azzolini Francesco, Viale Edi, Vespa Edoardo, Quario Lorenzo, Facciorusso Antonio, Fuccio Lorenzo, Mantovani Lorenzo Giovanni, Cortesi Paolo Angelo, Danese Silvio
Department of Gastroenterology and Gastrointestinal Endoscopy IRCCS San Raffaele Hospital Milan Italy.
Research Centre on Public Health (CESP) University of Milan-Bicocca Monza Italy.
DEN Open. 2025 Jun 5;6(1):e70151. doi: 10.1002/deo2.70151. eCollection 2026 Apr.
Non-anesthesiologist-administered propofol (NAAP) sedation for outpatient endoscopy has proven to be safe. However, implementing NAAP in Western countries faces challenges, and propofol-based sedation is still largely administered by anesthetists. For low-risk patients, anesthesiologist-administered propofol (AAP) could represent an avoidable waste of healthcare resources.
This research consisted of two phases. The first is a retrospective study comparing NAAP and AAP for outpatient endoscopy at a tertiary center, with the primary outcome being the rate of adverse events (AEs). Propensity score matching was performed to balance baseline characteristics between the two groups. The second phase involved a budget impact model to assess the economic impact of using NAAP instead of AAP for low-risk patients, both locally and nationally, between 2023 and 2025.
Between May 2019 and November 2021, 2721 patients undergoing esophagogastroduodenoscopies (EGDs; NAAP 2439 and AAP 282) and 2748 colonoscopies (NAAP 2491 and AAP 257) were enrolled. Overall, the AE rates were similar between the cohorts (esophagogastroduodenoscopies: NAAP 1.1% vs. AAP 0.8%, = 0.81; colonoscopies: NAAP 1.8% vs. AAP 3.5%, = 0.20). All NAAP-related AEs were minor.The budget impact model revealed that adopting NAAP instead of AAP would save €124,724,659 and 2223 working days for healthcare professionals for the Italian National Health System (NHS) between 2023 and 2025.
NAAP has a comparable AE rate to AAP for low-risk outpatient endoscopy. Implementing NAAP instead of AAP could save over €100 million and 2000 working days for the Italian NHS between 2023 and 2025. Wider adoption could improve healthcare resource allocation.
非麻醉医生实施丙泊酚（NAAP）用于门诊内镜检查已被证明是安全的。然而，在西方国家实施NAAP面临挑战，基于丙泊酚的镇静仍主要由麻醉医生进行。对于低风险患者，麻醉医生实施丙泊酚（AAP）可能是对医疗资源的一种可避免的浪费。
本研究包括两个阶段。第一阶段是一项回顾性研究，在一家三级中心比较NAAP和AAP用于门诊内镜检查的情况，主要结局是不良事件（AE）发生率。进行倾向评分匹配以平衡两组之间的基线特征。第二阶段涉及一个预算影响模型，以评估2023年至2025年期间在意大利本地和全国范围内，对低风险患者使用NAAP而非AAP的经济影响。
在2019年5月至2021年11月期间，纳入了2721例行食管胃十二指肠镜检查（EGD）的患者（NAAP组2439例，AAP组282例）以及2748例行结肠镜检查的患者（NAAP组2491例，AAP组257例）。总体而言，两组队列的AE发生率相似（食管胃十二指肠镜检查：NAAP组为1.1%，AAP组为0.8%，P = 0.81；结肠镜检查：NAAP组为1.8%，AAP组为3.5%，P = 0.20）。所有与NAAP相关的AE均为轻微事件。预算影响模型显示，对于意大利国家卫生系统（NHS），在2023年至2025年期间采用NAAP而非AAP将节省124,724,659欧元以及为医疗专业人员节省2223个工作日。
对于低风险门诊内镜检查，NAAP的AE发生率与AAP相当。在2023年至2025年期间，对意大利NHS而言，采用NAAP而非AAP可节省超过1亿欧元以及2000个工作日。更广泛地采用NAAP可改善医疗资源分配。
