Complications after gastrointestinal endoscopies appear to be higher than previous estimates. However, most of the problems are minor and the rate of serious complications is lower than previously anticipated, a study in this week's Archives of Internal Medicine shows.
The overall risk of complications was two to three times higher than had been reported. However, the risk of severe complications such as perforations and bleeding, heart attacks or even death, were lower than previous studies by about half, says study author Daniel Leffler, MD, director of clinical research at the Celiac Center at Beth Israel Deaconess Medical Center in Boston.
Leffler says electronic medical records might emerge as a better way to track complications from different hospital procedures.
About 15 million to 20 million GI endoscopic procedures are performed each year in the U.S. In this study, Beth Israel Deaconess Medical Center's electronic medical records were used to monitor emergency department visits and hospitalizations of patients who had had an endoscopy within the past two weeks. Previous research shows that most post-endoscopy-related hospital visits occur within two weeks after the procedure.
The system recorded 6,383 endoscopies and 11,632 colonoscopies between March 1 and Nov. 30, 2007. A total of 419 ED visits and 266 hospitalizations took place within two weeks following the procedures. Of these, 134 (32%) ED visits were related to complications related to the endoscopies, as were 76 (29%) of the hospitalizations. Traditional reporting by physicians recorded only 31 such complications, the study shows.
Almost half of the visits were due to abdominal pain, 12% to gastrointestinal tract bleeding and 11% involved chest pain. Older patients were more likely to have complications, the study found.
Most complications were minor but the cost of follow-up care was not. The average cost per ED visit following endoscopy was $1,403 and the average cost of hospitalization for post-procedure complications was $10,123, the study reports.
The findings may help guide how doctors counsel patients following one of these procedures. "We've done a lot over the years to mitigate the risks of bleeding and perforation, and rightly so," Leffler says. "Now [that] we know of the underlying iceberg of minor complications, we can really look at those because they're a significant burden to patients and the healthcare system."
John Commins is the news editor for HealthLeaders.