Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis.
Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis.
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DOI：
10.1016/j.gie.2011.06.023
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发表时间：
2011-10
影响因子：
7.7
通讯作者：
Somsouk, Ma
中科院分区：
文献类型：
--
作者：
Day, Lukejohn W.;Kwon, Annette;Inadomi, John M.;Walter, Louise C.;Somsouk, Ma
研究表明，高龄是结肠镜检查中发生不良事件的独立危险因素。然而，这些研究中的许多都受到样本量小和/或报告结果的显著差异的限制。确定接受结肠镜检查的老年患者特定不良事件的发生率，并计算选定对照组的发生率比。接受结肠镜检查的老年患者。系统综述和荟萃分析。穿孔、出血、心血管(CV)/肺部并发症和死亡率。我们的文献检索得到3328篇文章，其中20篇研究符合我们的纳入标准。65岁及以上患者的不良事件(每1000例结肠镜检查)的合并发生率为：累计胃肠道不良事件26.0(95%CI，25.0-27.0)，穿孔1.0(95%CI，0.9-1.5)，胃肠道出血6.3(95%CI，5.7-7.0)，心血管/肺部并发症19.1(95%CI，18.0-20.3)，死亡率1.0(95%CI，0.7-2.2)。在80岁以上的老年人中，不良事件发生率(每1000例结肠镜检查)如下：累计胃肠道不良事件发生率34.9(95%CI，31.9~38.0)，穿孔率1.5(95%CI，1.1~1.9)，消化道出血率2.4(95%CI，1.1~4.6)，心血管/肺部并发症发生率28.9(95%CI，26.2~31.8)，死亡率0.5(95%CI，0.06~1.9)。与80岁以下患者相比，80岁及以上患者的累积胃肠道不良事件发生率更高(发生率比1.7；95%可信区间1.5-1.9)，穿孔风险更大(发生率比1.6，95%可信区间1.2-2.1)。在80多岁的老年人中，胃肠道出血和心血管/肺部并发症的发生率有增加的趋势，但这两种情况在统计学上都不显着。纳入的研究的异质性，并不是所有与结肠镜检查相关的并发症都被记录下来。老年患者，尤其是80多岁的患者，在结肠镜检查中和之后出现并发症的风险似乎更高。这些数据应该为临床决策、同意过程、公共卫生政策和比较有效性分析提供信息。
Studies suggest that advancing age is an independent risk factor for experiencing adverse events during colonoscopy. Yet many of these studies are limited by small sample sizes and/or marked variation in reported outcomes. To determine the incidence rates for specific adverse events in elderly patients undergoing colonoscopy and calculate incidence rate ratios for selected comparison groups. Elderly patients undergoing colonoscopy. Systematic review and meta-analysis. Perforation, bleeding, cardiovascular (CV)/pulmonary complications, and mortality. Our literature search yielded 3328 articles, of which 20 studies met our inclusion criteria. Pooled incidence rates for adverse events (per 1000 colonoscopies) in patients 65 years of age and older were 26.0 (95% CI, 25.0–27.0) for cumulative GI adverse events, 1.0 (95% CI, 0.9–1.5) for perforation, 6.3 (95% CI, 5.7–7.0) for GI bleeding, 19.1 (95% CI, 18.0–20.3) for CV/pulmonary complications, and 1.0 (95% CI, 0.7–2.2) for mortality. Among octogenarians, adverse events (per 1000 colonoscopies) were as follows: cumulative GI adverse event rate of 34.9 (95% CI, 31.9–38.0), perforation rate of 1.5 (95% CI, 1.1–1.9), GI bleeding rate of 2.4 (95% CI, 1.1–4.6), CV/pulmonary complication rate of 28.9 (95% CI, 26.2–31.8), and mortality rate of 0.5 (95% CI, 0.06–1.9). Patients 80 years of age and older experienced higher rates of cumulative GI adverse events (incidence rate ratio 1.7; 95% CI, 1.5–1.9) and had a greater risk of perforation (incidence rate ratio 1.6, 95% CI, 1.2–2.1) compared with younger patients (younger than 80 years of age). There was an increased trend toward higher rates of GI bleeding and CV/pulmonary complications in octogenarians but neither was statistically significant. Heterogeneity of studies included and not all complications related to colonoscopy were captured. Elderly patients, especially octogenarians, appear to have a higher risk of complications during and after colonoscopy. These data should inform clinical decision making, the consent process, public health policy, and comparative effectiveness analyses.
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影响因子：
254.7
作者：
Jemal, Ahmedin;Siegel, Rebecca;Thun, Michael J.
通讯作者：
Thun, Michael J.
影响因子：
7.7
作者：
Arora, A;Singh, P
通讯作者：
Singh, P
影响因子：
7.7
作者：
Arora, Gaurav;Mannalithara, Ajitha;Triadafilopoulos, George
通讯作者：
Triadafilopoulos, George
影响因子：
5.1
作者：
BAT, L;PINES, A;ROSENBLUM, Y
通讯作者：
ROSENBLUM, Y
影响因子：
0.6
作者：
Fontagnier, EM;Manegold, BC
通讯作者：
Manegold, BC