Risk Factors for Aspiration Pneumonia in Ambulatory Endoscopy Patients: 1892

Purpose: With the increased volume of endoscopic procedures performed with propofol in ambulatory centers in recent years, the pattern of risks and complications may have changed. In one prospective study, the 30-day mortality rate in patients undergoing endoscopy was 0.07% (1:1,537 procedures), which was often due to bronchopneumonia. We identify factors associated with developing aspiration pneumonia as a complication of routine esophagogastroduodenoscopy (EGD) and colonoscopy in our ambulatory endoscopy center (AEC). Methods: A retrospective case-control study was performed on patients recorded to have a suspected intra-procedure aspiration in the AEC database between 2007 and 2012. We recorded patient age, gender, type of procedure, total procedure length (minutes), history of gastroesophageal reflux disease (GERD), body mass index (BMI) and whether abdominal pressure was utilized. Comparison was made to an age, sex and procedure matched control group from the same center. All patients received propofol for anesthesia. Results: Aspiration pneumonia was identified in 17 patients, 11 of whom underwent colonoscopies (n=15,137), four had EGD (n=4,529), and two had both procedures (n=949). The median age was 64.7 years (range 33-75). Eleven patients had history of GERD. The median procedure length was 22 minutes (range 8-52 minutes). The procedure was aborted in one case. Abdominal pressure was utilized in only two patients. Compared to age and sex matched controls, aspiration pneumonia patients were heavier (mean BMI 30.8 vs. 26.0, respectively; p=0.01). Cases and controls did not differ by any of the other factors studied. Conclusion: Intra-procedure aspiration pneumonia was associated with higher BMI, compared to age and sex matched controls. The majority of aspiration cases occurred with colonoscopy. Further studies are needed to investigate predictors of aspiration pneumonia in ambulatory settings. This may provide an opportunity for risk stratification prior to endoscopy in the ambulatory patient population.Figure