Cardiovascular complications after GI endoscopy: occurrence and risks in a large hospital system

Gangi, Sumana; Saidi, Firas; Patel, Kapil; Johnstone, Barbara; Jaeger, Joseph; Shine, Daniel

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Volume 60, Issue 5 , Pages 679-685, November 2004

Cardiovascular complications after GI endoscopy: occurrence and risks in a large hospital system

Current affiliations: Department of Medicine, Monmouth Medical Center, Long Branch, New Jersey, Department of Decision Support, Saint Barnabas Healthcare System, Livingston, New Jersey, Department of Medical Education, Monmouth Medical Center, Long Branch, New Jersey.

Received 17 December 2003; received in revised form 28 April 2004; accepted 16 June 2004.

Long Branch, New Jersey, Livingston, New Jersey

Background

There is limited information concerning the risks for, and occurrence of, cardiovascular complications because of GI endoscopy. Published data are based on questionnaire surveys, which have a potential for bias. Moreover, available studies pertain exclusively to out-patients.

Methods

In-patients and day-stay patients who incurred charges for endoscopy with endoscopic procedure coding from 1999 through 2001 were identified from a financial database for all 9 hospitals in a large health care system. From these patients, those considered “at risk” for cardiovascular complications were selected based on charges for cardioactive medications, cardiac enzyme determinations, or intensive care services on the day of or the day after endoscopy. Medical records were reviewed for 25% of these patients, selected at random, noting demographics, history, and a modified Goldman score in patients with cardiovascular complications (defined as arrhythmia, chest pain or anginal equivalent, hypotension or myocardial infarction occurring within 24 hours after endoscopy). Identical information was obtained from a random sample of 0.5% of the chart records for all patients undergoing endoscopy.

Results

Patients who underwent endoscopy were not reliably identified for one hospital. This hospital was omitted from the calculation of the extrapolated rate of complication occurrence, but patients identified through chart review as having or not having a complication after endoscopy were included in the risk analysis. The extrapolated rate of occurrence of cardiovascular complications was 308: 95% CI [197, 457] per 100,000 procedures. Independent risk factors were: male gender, modified Goldman score, and use of propofol.

Conclusions

In this study of patients undergoing hospital-based GI endoscopy, the risk of procedure-related cardiovascular complications was 2 to 70 times higher than previously reported. This finding may be ascribed to differences in the populations sampled and to a case-finding method that minimized reporting and ascertainment biases.