Endoscopic Complications In Community Endoscopic Ambulatory Surgery Centers (Eascs)

Background: There are few published reports of endoscopic complications(EC)in U.S. EASCs. Benchmarks for EC derive largely from surveys, academic, or hospital environments. The profound increase of endoscopic procedures performed in EASCs and the evolving interest in value-based health care focus greater attention on relevant measures of endoscopic outcomes. Methods: Endoscopic complications of 13 board certified endoscopists were prospectively evaluated by the Quality Improvement Committee of two EASCs from 1995-2004. Complications were identified by 1)the endoscopy team at the time of the procedure 2)routine nurse follow-up calls to all patients 2)physician reporting of delayed complication and 3)physician reporting from a monthly review of a patient procedure list. Results: 20,626 EGDs(excluding PEGs) and 42,585 colonoscopies were performed. Complication rates are shown in Table 1. Published complication benchmarks include: Colonoscopy perforation 0.1-0.3%; Colon/polypectomy bleeding 0.3-6%; Colonoscopy total 0.2-0.3%; EGD death 0.004%; EGD perforation 0.03%; EGD total 0.13%. Other than “Death” the complication type does not adequately quantify the clinical significance of the complication. For example, bleeding may be life-threatening, or it may require no intervention. “Other” includes common minor complications such as transient pain, as well as rare but serious complications such as myocardial infarction and splenic rupture. Sixty-one complications in 2002-04 were classified using the ODD score reported by Fleischer et al in 1997. The ODD score uses a numerical scale to quantify immediate and delayed negative outcomes(O), residual disability(D), and death(D) as shown in Table 2. Conclusions: EASC complication rates for perforation, bleeding, and death compare favorably with previously published benchmarks. Classification of complications by type is not sufficient to quantify the true clinical relevance of the complication. Application of the ODD score quantifies complication severity in a way that is a more clinically relevant measurement of endoscopic outcomes. Table 1Complications Procedure Total Death % Perforation % Bleed % Other % % Total Colonoscopy/All 42585 7 0.016 20 0.047 51 0.120 48 0.113 0.279 Colonoscopy/Polyp 11793 0 0.000 7 0.059 44 0.373 13 0.110 0.543 EGD/All 20626 2 0.010 9 0.044 10 0.048 32 0.155 0.247 EGD/Dilation 5995 1 0.017 9 0.150 2 0.033 12 0.200 0.384 Open table in a new tab Table 2Complications by ODD Score Range ODD Score Range 0-20 21-40 41-60 61-80 81-100 100+ # of Complications 14 28 5 7 3 4 Open table in a new tab