Rates of Minor Adverse Events and Health Resource Utilization Postcolonoscopy

Abstract

BACKGROUND: Little is known about minor adverse events (MAEs) following outpatient colonoscopies and associated health care resource utilization.OBJECTIVE: To estimate the rates of incident MAE at two, 14 and 30 days postcolonoscopy, and associated health care resource utilization. A secondary aim was to identify factors associated with cumulative 30-day MAE incidence.METHODS: A longitudinal cohort study was conducted among individuals undergoing an outpatient colonoscopy at the Montreal General Hospital (Montreal, Quebec). Before colonoscopy, consecutive individuals were enrolled and interviewed to obtain data regarding age, sex, comorbidities, use of antiplatelets/anticoagulants and previous symptoms. Endoscopy reports were reviewed for intracolonoscopy procedures (biopsy, polypectomy). Telephone or Internet follow-up was used to obtain data regarding MAEs (abdominal pain, bloating, diarrhea, constipation, nausea, vomiting, blood in the stools, rectal or anal pain, headaches, other) and health resource use (visits to emergency department, primary care doctor, gastroenterologist; consults with nurse, pharmacist or telephone hotline). Rates of incident MAEs and health resources utilization were estimated using Bayesian hierarchical modelling to account for patient clustering within physician practices.RESULTS: Of the 705 individuals approached, 420 (59.6%) were enrolled. Incident MAE rates at the two-, 14- and 30-day follow-ups were 17.3% (95% credible interval [CrI] 8.1% to 30%), 10.5% (95% CrI 2.9% to 23.7%) and 3.2% (95% CrI 0.01% to 19.8%), respectively. The 30-day rate of health resources utilization was 1.7%, with 0.95% of participants seeking the services of a physician. No predictors of the cumulative 30-day incidence of MAEs were identified.DISCUSSION: The incidence of MAEs was highest in the 48 h following colonoscopy and uncommon after two weeks, supporting the Canadian Association of Gastroenterology’s recommendation for assessment of late complications at 14 days. Predictors of new onset of MAEs were not identified, but wide CrIs did not rule out possible associations. Although <1% of participants reported consulting a physician for MAEs, this figure may represent a substantial number of visits given the increasing number of colonoscopies performed annually.CONCLUSION: Postcolonoscopy MAEs are common, occur mainly in the first two weeks postcolonoscopy and result in little use of health resources.

Association of Colonoscopy With Risk of Appendicitis

“…Nor is appendicitis a diagnosis like hypertension that would be more likely to be an incidental finding on a precolonoscopy history and physical examination. Patients seek medical attention more frequently after undergoing a colonoscopy for colonoscopy-related complaints including bleeding, bloating, and pain, so one could hypothesize that an increased likelihood of complaining of abdominal symptoms might increase the likelihood of diagnosing appendicitis, but all of the index cases of appendicitis in the final analysis were pathologically confirmed, so these were not false-positive diagnoses. Appendicitis may sometimes resolve spontaneously, but the rate at which this occurs is difficult to distinguish from the resolution of abdominal pain during conservative management that was not appendicitis.…”

“…First, the authors indicated that vascular invasion is not a poor prognostic factor for patients with ICC, which is contrary to previous studies. 2 Moreover, the prognostic nomogram constructed by Yeh et al 3 has been validated by 3 external populations. We considered that there were some potential confounders affecting the authors' conclusion.…”

Canadian Association of Gastroenterology Indicators of Safety Compromise following Colonoscopy in Clinical Practice

“…A study that used follow-up by phone call at 7 and 30 days after colonoscopy found six of 21,375 patients (0.03%) required hospitalization for abdominal pain that was not from perforation [ 13 ]. In a recent Canadian study, of 420 patients contacted two days after colonoscopy 8.6% complained of abdominal pain that did not require medical attention [ 14 ]. In our study, we observed persistent abdominal pain requiring medical attention in 0.4% of patients, though only 2 patients (0.06%) required admission for abdominal pain after colonoscopy; one had an uneventful recovery and the other was diagnosed with Crohn's disease.…”

“…Azalgara et al observed that of 420 patients who had colonoscopy, 7 (1 in 60) required the care of any health professional within 30 days for minor adverse events [ 14 ]. We found the same in our cohort with 1.8% (1 in 55) having unplanned contact with a heath professional within 14 days of colonoscopy.…”

What Patients Want in a Smartphone App That Supports Colonoscopy Preparation: Qualitative Study to Inform a User-Centered Smartphone App (Preprint)

“…About 25% of patients experience a minor adverse event within 48 hours of a colonoscopy and 0.5% experience a serious adverse event within 30 days [38]. Given the high frequency of adverse events, providing details on the common adverse events and their degrees of severity in the app could result in fewer consultations with health care providers for complications that are self-limited [39]. To reduce arousing fear and anxiety, information on adverse events could be available but not imposed as an app feature.…”