The Impact of Hospital Teaching Status on Colonoscopy Perforation Risk: A National Inpatient Sample Study

Abstract

Background: Colonoscopy has been widely used as a diagnostic tool for many conditions, including inflammatory bowel disease and colorectal cancer. Colonoscopy complications include perforation, hemorrhage, abdominal pain, as well as anesthesia risk. Although rare, perforation is the most dangerous complication that occurs in the immediate post-colonoscopy period with an estimated risk of less than 0.1%. Studies on colonoscopy perforation risk between teaching hospitals and non-teaching hospitals are scarce. Methods: The National Inpatient Sample database was queried for patients who underwent inpatient colonoscopy between January 2010 and December 2014 in teaching versus non-teaching facilities in order to study their perforation rates. Our study population included 257,006 patients. Univariate regression was performed, and the positive results were analyzed using a multivariate regression module. Results: Teaching hospitals had a higher risk of perforation (odds ratio 1.23, confidence interval 1.07-1.42, P = 0.004). Perforation rates were higher in females, patients with inflammatory bowel disease and dilatation of strictures. Polypectomy did not yield any statistical difference between the study groups. Other factors such as African-American ethnicity appeared to have a lower risk. Conclusion: Perforation rates are higher in teaching hospitals. More studies are needed to examine the difference and how to mitigate the risks.

Colonoscopy Complications in an Iranian Teaching Hospital

“… 4 Khalid and colleagues performed a retrospective analysis of a national database in the USA and found a higher rate of perforation in teaching hospitals compared with rural and non-teaching urban hospitals (OR = 1.23, CI 1.07 - 1.42, P = 0.004). 6 However, we believe that this statistical significance reflects the large sample size (n = 257006) of their study and the odds ratio of 1.2 is not clinically important. Desai and others showed that the rate of post-colonoscopy perforation, bleeding, and infection was not higher during the early academic months.…”

“…The rate of complications from colonoscopy in this study at a tertiary care teaching hospital was consistent with the rates reported in other studies worldwide. [5][6][7][8][9][10][11] These results represent the complication rates at public teaching hospitals where the procedure is performed by fellows in training supervised by experienced gastroenterologists, which can provide reassurance to patients.…”

“…Few studies have reported complication rates of colonoscopy in teaching hospital environments. [5][6] Data on the rate of complications in our country are also sparse. To our knowledge, there is only one study from Iran that has reported the complications rate of colonoscopy by an expert gastroenterologist.…”

“…Few studies have reported complication rates of colonoscopy in teaching hospital environments. 5 - 6 …”

Bleeding and Perforation Complications after Follow-Up Colonoscopies in Faecal Immunochemical Test-Based Colorectal Cancer Screening: Insights from a Retrospective Case–Control Study

“…Colonoscopy has been widely used since its introduction in the 1960s [1]. It has served a critical role in colorectal cancer (CRC) management, functioning both as a primary screening test and as a follow-up diagnostic procedure after an abnormal result from another primary screening test (e.g., a faecal occult blood test).…”