Perforations and haemorrhages after colonoscopy in 2010: A study based on comprehensive French health insurance data (SNIIRAM)
Perforations and haemorrhages after colonoscopy in 2010: A study based on comprehensive French health insurance data (SNIIRAM)
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DOI：
10.1016/j.clinre.2013.10.005
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发表时间：
2014-02-01
影响因子：
2.7
通讯作者：
Allemand, Hubert
中科院分区：
文献类型：
--
作者：
Blotiere, Pierre-Olivier;Weill, Alain;Allemand, Hubert
背景和目的：估计2010年法国人群结肠镜检查后的穿孔和出血率，并确定这些并发症的危险因素。方法：基于SNIIRAM和PMSI数据库的研究。排除接受IBD或结直肠癌治疗的患者。研究了两种类型的并发症：穿孔和出血。调整患者（性别，年龄，慢性疾病）和结肠镜检查（息肉切除术，急诊）的特点的OR计算通过使用logistic回归model.Results：队列由947,061人。估计穿孔率为4.5 - 9.7/10，000例手术，估计出血率为9.9 - 11.0/10，000例手术。与穿孔和出血相关的主要危险因素是患者年龄（80岁以上与40岁以下相比，OR = 7.51和3.23）、切除大于1cm或大于4个息肉（与未切除息肉相比，OR = 2.72和5.12）和急诊结肠镜检查（OR = 4.63和5.99）。胃肠病学家每年进行少于244次结肠镜检查与穿孔风险增加相关（OR = 2.29）。并发症发生率较高的机构进行不到510结肠镜检查，每年，但这不再是紧急colonoscopies.Conclusions调整后的情况：这项研究，其中包括近百万结肠镜检查，建议考虑到胃肠病学家的结肠镜检查的数量，以确保最佳的组织管理非常老年患者需要结肠镜检查。(C)2013年Elsevier Masson SAS。All rights reserved.
Background and objective: To estimate the perforation and haemorrhage rate after colonoscopy in the French population in 2010 and to identify risk factors for these complications.Method: Study based on SNIIRAM and the PMSI databases. Patients treated for IBD or colorectal cancer were excluded. Two types of complications were investigated: perforation and haemorrhage. OR adjusted for patient (gender, age, chronic disease) and colonoscopy (polypectomy, emergency) characteristics were calculated by using a logistic regression model.Results: The cohort was composed of 947,061 individuals. The estimated perforation rate was between 4.5 and 9.7 per 10,000 procedures and the estimated haemorrhage rate was between 9.9 and 11.0 per 10,000 procedures. The main risk factors associated with perforation and haemorrhage were the patient's age (over 80 years compared to under 40, OR = 7.51 and 3.23), resection of polyps larger than 1 cm or more than 4 polyps (compared to no polypectomy, OR = 2.72 and 5.12) and emergency colonoscopy (OR = 4.63 and 5.99). Colonoscopy performed by a gastroenterologist performing less than 244 colonoscopies per year was associated with an increased risk of perforation (OR = 2.29). Complication rates were higher in institutions performing less than 510 colonoscopies per year, but this was no longer the case after adjustment for emergency colonoscopies.Conclusions: This study, which includes nearly one million colonoscopies, suggests taking the gastroenterologist's number of colonoscopies into account to ensure optimal organization of the management of very elderly patients requiring colonoscopy. (C) 2013 Elsevier Masson SAS. All rights reserved.