Emergency readmission after endoscopy linked to mortality risk

Aug 30 2012

The risk for mortality is significantly increased among patients who are readmitted urgently following endoscopy, compared with other endoscopy patients, a UK study shows.

The authors also found that cardiovascular and respiratory events were a major cause of readmissions.

"This study shows that we may underestimate adverse events following endoscopy in high-risk patients," write Sanchoy Sarkar (Royal Liverpool University Hospital, UK) and colleagues. "We may need to consider preassessing the fitness of these patients for endoscopy and the importance of proper monitoring during and perhaps for prolonged periods after the procedure."

The multicenter study reviewed data on 29,868 day-case upper endoscopy (UE) and lower endoscopy (LE) procedures performed over a period of 12 months. The authors examined rates of emergency readmission within 6 days of discharge and 30-day mortality of all patients.

The overall readmission rate was 0.5%. The readmission rate for therapeutic UE was significantly higher than for other types of endoscopy at 1.74%, compared with 0.5% for diagnostic UE, 0.4% for diagnostic LE, and 0.6% for therapeutic LE.

Cardiovascular and respiratory events were the most common reasons for readmissions, accounting for 36.7% overall. They were significantly more frequent after UE than LE (0.25 vs 0.1%). The next most frequent reasons for readmission included symptoms of particular pain, gastrointestinal bleeding, and perforation.

Overall, 19 of the 235 readmitted patients died. The 30-day mortality rate of all patients who underwent endoscopy was 0.06%. However, in patients who were readmitted, this increased significantly to 6.8%.

The authors found that patients who died had a mean age of 74 years compared with 65.2 years in the overall study population and commonly had a cancer diagnosis, indicating that endoscopy in these patients may represent futile procedures: "While often clinically and ethically difficult, careful assessment and alternative test or conservative investigations may be a better option, given the high 30-day mortality in these patients."

The authors also draw attention to the financial consequences of readmission. In their study, the 147 procedure-related readmissions lead to an additional 1194 bed days, which the authors say equates to around £ 478,000 (US$ 760,000; € 604,000) in costs.

"This study has highlighted that cardiorespiratory events are potentially a major cause of readmissions postendoscopy that has not been well identified previously," the authors conclude in the European Journal of Gastroenterology and Hepatology, adding: "All readmissions are potentially avoidable and our study has highlighted that these patients can potentially have poor outcomes, with significant mortality."

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