Risk of adverse events in gastrointestinal endoscopy: Zero-inflated Poisson regression mixture model for count data and multinomial logit model for the type of event

Abstract

Background and aims We analyze the possible predictive variables for Adverse Events (AEs) during sedation for gastrointestinal (GI) endoscopy. Methods We consider 23,788 GI endoscopies under sedation on adults between 2012 and 2019. A Zero-Inflated Poisson Regression Mixture (ZIPRM) model for count data with concomitant variables is applied, accounting for unobserved heterogeneity and evaluating the risks of multi-drug sedation. A multinomial logit model is also estimated to evaluate cardiovascular, respiratory, hemorrhagic, other AEs and stopping the procedure risk factors. Results In 7.55% of cases, one or more AEs occurred, most frequently cardiovascular (3.26%) or respiratory (2.77%). Our ZIPRM model identifies one population for non-zero counts. The AE-group reveals that age >75 years yields 46% more AEs than age <66 years; Body Mass Index (BMI) ≥27 27% more AEs than BMI <21; emergency 11% more AEs than routine. Any one-point increment in the American Society of Anesthesiologists (ASA) score and the Mallampati score determines respectively a 42% and a 16% increment in AEs; every hour prolonging endoscopy increases AEs by 41%. Regarding sedation with propofol alone (the sedative of choice), adding opioids to propofol increases AEs by 43% and adding benzodiazepines by 51%. Cardiovascular AEs are increased by age, ASA score, smoke, in-hospital, procedure duration, midazolam/fentanyl associated with propofol. Respiratory AEs are increased by BMI, ASA and Mallampati scores, emergency, in-hospital, procedure duration, midazolam/fentanyl associated with propofol. Hemorrhagic AEs are increased by age, in-hospital, procedure duration, midazolam/fentanyl associated with propofol. The risk of suspension of the endoscopic procedure before accomplishment is increased by female gender, ASA and Mallampati scores, and in-hospital, and it is reduced by emergency and procedure duration. Conclusions Age, BMI, ASA score, Mallampati score, in-hospital, procedure duration, other sedatives with propofol increase the risk for AEs during sedation for GI endoscopy.

Developing clinical prediction models for nominal polytomous outcomes: a simulation study comparing available approaches

“…We found that the OvO-PC method had comparative performance to MLR across all scenarios in the simulation, but it has been shown to have better performance than MLR in a clinical example when variable selection was implemented on each sub-model. 4 It is therefore possible OvO-PC could provide improved performance over the commonly implemented MLR, [18][19][20][21][22][23][24][25][26] in scenarios where variable selection is required. Variable selection for MLR is beyond the scope of this work but should be considered in the future.…”

“…[11][12][13][14][15][16][17] However, an outstanding question is which of these methods are most suitable for developing prediction models for nominal polytomous outcomes. In practice, MLR is the most commonly used method to model nominal outcomes, [18][19][20][21][22][23][24][25][26] however a comprehensive evaluation of the most appropriate method in this setting does not exist. A recent simulation has compared the calibration of different models for the prediction of an ordinal outcome, 27 but no such simulation exists for nominal outcomes.…”

Development and validation of a scoring system to predict esophagogastroduodenoscopy necessity

“…In gastroenterology, AI has been found widely applied in various aspects, including disease detection, diagnosis, treatment decision-making, long-term prognosis, and the optimization of medical environments, 12 with a particular emphasis on image recognition in endoscopy. While several prediction models have been developed for various digestive diseases, they often focus on a single specific outcome of interest; for instance, prediction models for cancers, upper GI bleeding, [13][14][15] endoscopic complications, 16 or adverse effects, 17 assessment for irritable bowel syndrome, [18][19][20] and liver disease. 21 Many of these models also necessitate laboratory tests, which introduce limitations in terms of usability and result accuracy.…”

Safety, Efficacy and High-Quality Standards of Gastrointestinal Endoscopy Procedures in Personalized Sedoanalgesia Managed by the Gastroenterologist: A Retrospective Study

“…In this work, the analysis of the vital parameters from the dataset of patients who underwent an endoscopy with sedoanalgesia showed that there were no clinically significant differences between the average values of BP, HR and SpO 2 at the beginning of the procedure and those recorded at the end of the procedure, denoting the safety of sedoanalgesia in this setting. As for anesthesia-related complications, these occurred in 0.8% (4 cases out of 529), while the literature reports adverse events during sedoanalgesia with benzodiazepine and opioids (hypotension, respiratory depression) in percentages ranging from 0.47% to 17% [ 31 ]. In this study, all the cases of anesthesia-related complication required an IV bolus infusion of atropine due to persistent bradycardia (HR < 50 bpm) and hypotension (mean pre-sedation level BP value < 50 mmhg).…”