Background and Aims
Monitoring adverse events (AEs) after GI endoscopy is an endorsed quality measure
but is challenging to implement in practice. Patients with major AEs may seek care
elsewhere after endoscopy. We aimed to determine the hospital utilization patterns
of patients with AEs after ambulatory endoscopy.
Methods
We used the HealthLNK Data Repository, which uses a software application for integration
of deidentified, patient-level clinical data across institutions. Data for patients
undergoing outpatient endoscopy from 2010 to 2011 at 5 Chicago-area hospitals were
used. Early mortality was defined as death no more than 2 months after the outpatient
procedure. AEs were defined as a hospital admission for perforation, bleeding, or
pancreatitis the same or following month after endoscopy.
Results
During the study period, 42,842 outpatient procedures were performed in 22,898 unique
individuals. Early mortality occurred in 86 patients (.4%). Per-patient mortality
was greatest after outpatient ERCP (2.5%, P < .0001). Of 86 patients with early mortality, 36 (42%) were not hospitalized at
the index hospital after endoscopy. Patients who did not return to the index hospital
lived farther from the index hospital (P = .02). In total, 8.3% of ambulatory endoscopies were associated with potential endoscopy-related
AEs. The observed rate of potential AEs trended downward as patients’ home zip codes
moved farther from the index hospital (P = .01).
Conclusions
Nearly half of patients who die soon after outpatient endoscopy are not hospitalized
at their index hospital after endoscopy. The observed AE rate was higher for patients
living closer to the index hospital, suggesting that patients who live farther away
are less likely to return to the index hospital for emergency care. Novel methods
to efficiently track outcomes after outpatient endoscopy are needed.
Abbreviations:
AE (adverse event), ED (emergency department), HDR (HealthLNK Data Repository)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 13, 2016
Accepted:
August 1,
2016
Received:
March 25,
2016
Footnotes
DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: R. N. Keswani: Consultant for Boston Scientific and Cook Medical. All other authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Keswani at [email protected]
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