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Reporting Procedures Lead To Underestimating Endoscopy Complications

Tue, 10/26/2010 - 5:26am

Hospital visits following outpatient gastrointestinal endoscopies may be more common than previously estimated, according to a recent report in the Archives of Internal Medicine, one of the JAMA/Archives journals. About 15 to 20 million endoscopic procedures are performed each year in the United States, according to background information in the article. However, data on the safety of these procedures and the complications occurring afterward are limited. Most estimates have relied on physician reporting, review of medical records and follow-up interviews, which may not capture all adverse events related to endoscopy.

Daniel A. Leffler, M.D., M.S., and colleagues at Beth Israel Deaconess Medical Center, Boston, used that facility's electronic medical records to develop a system that automatically recorded admissions to the emergency department within 14 days after endoscopy. They then evaluated each reported case to determine if the visit was related to the endoscopy based on pre-determined criteria, including whether the chief complaint in the emergency department pre-dated the endoscopy.

Between March 1 and November 30, 2007, 6,383 patients underwent endoscopies of the upper gastrointestinal tract and 11,632 had colonoscopies. The standard physician reporting recorded 31 complications, the authors note. "Although the overall rate of severe complications, including perforation, myocardial infarction (heart attack) and death remained low, the true range of adverse events is much greater than typically appreciated, and the overall rate of one in 127 patients visiting the hospital due to an outpatient endoscopic procedure is a cause for concern, especially in the setting of screening and surveillance when otherwise healthy individuals are subjected to procedural risks," they write.

The average cost per hospital visit following endoscopy was $6,355.71. The total cost for hospitalizations among patients undergoing endoscopy for screening or surveillance was $355,489.76, adding $48.09 per examination to the cost of the screening program. "The overall cost of hospital visits related to endoscopy at our center was nearly $1.4 million per year with an incremental cost of approximately four percent to the screening program," the authors write. "Although on an individual basis this cost is relatively low, projected nationwide, this is a considerable and underreported cost to the medical system, which could exceed $650 million per year in the United States."

"Using a novel automated system, we observed a one percent incidence of related hospital visits within 14 days of outpatient endoscopy, two to three-fold higher than recent estimates," they conclude. "Most events were not captured by standard reporting, and strategies for automating adverse event reporting should be developed. The cost of unexpected hospital visits post-endoscopy may be significant and should be taken into account in screening or surveillance programs."

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