Risk of perforation from a colonoscopy in adults: a large population-based study
Risk of perforation from a colonoscopy in adults: a large population-based study
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DOI：
10.1016/j.gie.2008.09.008
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发表时间：
2009-03-01
影响因子：
7.7
通讯作者：
Triadafilopoulos, George
中科院分区：
文献类型：
--
作者：
Arora, Gaurav;Mannalithara, Ajitha;Triadafilopoulos, George
背景：之前报告结肠镜检查穿孔发生率的研究受到样本量小、年龄组限制或单中心数据的限制。目的：确定大人群队列中结肠镜检查结肠穿孔的发生率和危险因素。设计：回顾性、基于人群的队列研究，随后进行巢式病例对照研究。背景：加州医疗补助计划索赔数据库。患者：总共 277,434 名患者（年龄 18 岁1995 年至 2005 年期间接受结肠镜检查的年龄、性别和时间与 4 个独特的一般人群对照相匹配。多变量逻辑回归计算调整后的 OR，用于随后的危险因素分析。结果：277,434 次结肠镜检查后总共诊断出 228 例穿孔，相当于 7 天累积发生率为 0.082%。与未接受结肠镜检查的匹配对照 (n = 1,072,723) 相比，通过结肠镜检查发现穿孔的 OR 为 27.6 (95% CI, 19.04-39-92)，P < .001。在多变量分析中，当比较结肠镜检查后穿孔的组（n = 21.6）与未穿孔的组（n = 269,496）时，年龄增加、明显的合并症、作为结肠镜检查指征的梗阻以及结肠镜检查期间进行侵入性干预是显着的阳性预测因素。活检或息肉切除术的进行并不影响穿孔风险。随着时间的推移，穿孔率没有显着变化。局限性：所有穿孔诊断的编码和捕获的有效性可能存在缺陷。结论：结肠镜检查穿孔的风险很低，但是，尽管手术经验增加，但随着时间的推移，穿孔的风险保持不变。 （胃肠测试 Endosc 2009；69：654-64。）
Background: Previous studies that reported the incidence of perforation from a colonoscopy are limited by small sample sizes, restricted age groups, or single-center data.Objective: To determine the incidence and risk factors of colonic perforation from a colonoscopy in a large population cohort.Design: Retrospective, population-based, cohort study, followed by a nested case-control study.Setting: California Medicaid program claims database.Patients: A total of 277,434 patients (aged 18 years and older) who underwent a colonoscopy during 1995 to 2005, age, sex, and time matched to 4 unique general-population controls.Main Outcome Measurements: Perforation incidence in the 7 days after colonoscopy (or matched index date for controls) with odds ratio (OR); multivariate logistic regression to calculate adjusted ORs for subsequent analysis of risk factors.Results: A total of 228 perforations were diagnosed after 277,434 colonoscopies, which corresponded to a cumulative 7-day incidence of 0.082%. The OR of getting a perforation from a colonoscopy compared with matched controls (n = 1,072,723) who did not undergo a colonoscopy was 27.6 (95% CI, 19.04-39-92), P < .001. On multivariate analysis, when comparing the group that had a perforation after a colonoscopy (n = 21.6) with those who did not (n = 269,496), increasing age, significant comorbidity, obstruction as an indication for the colonoscopy, and performance of invasive interventions during colonoscopy were significant positive predictors. Performance of biopsy or polypectomy did not affect the perforation risk. The rate of perforation did not change significantly over time.Limitations: Validity of coding and capturing of all perforation diagnoses may possibly he deficient.Conclusion: The risk of perforation from a colonoscopy is low, but, despite increased experience with the procedure, it remains unchanged over time. (Gastrointest Endosc 2009;69:654-64.)