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Patient Comorbidity and Serious Adverse Events after Outpatient Colonoscopy: Population-based Study From Three States, 2006 to 2009

Chukmaitov, Askar M.D., Ph.D.1; Siangphoe, Umaporn Ph.D.1; Dahman, Bassam Ph.D.1; Bradley, Cathy J. Ph.D.2; BouHaidar, Doumit M.D., A.G.A.F.3

Diseases of the Colon & Rectum: July 2016 - Volume 59 - Issue 7 - p 677–687
doi: 10.1097/DCR.0000000000000603
Original Contributions: Endoscopy

BACKGROUND AND OBJECTIVE: Serious GI adverse events in the outpatient setting were examined for patients with a full spectrum of comorbid conditions and combinations of multiple comorbidities.

DESIGN: This is a retrospective follow-up study.

SETTING: Ambulatory surgery and hospital discharge data sets from California, Florida, and New York, 2006 to 2009, were used.

PATIENTS: The outpatient colonoscopies of 4,234,084 adults aged 19 to 85 and over and payers were examined.

MAIN OUTCOME: Thirty-day hospitalizations due to colonic perforations and GI bleeding, measured as cumulative outcomes, were investigated.

RESULTS: About 24% of patients undergoing outpatient colonoscopy had a comorbid condition. In comparison with patients without comorbidities, the adjusted risks of adverse events were greater for patients with several single comorbidities and combinations of multiple comorbid conditions. Elderly patients and those treated in freestanding Ambulatory Surgery Centers had higher odds of colonic perforations and GI bleeding than younger patients and patients treated in hospital outpatient departments.

LIMITATION: The study was constrained by limitations inherent in administrative data.

CONCLUSIONS: Given the large number of outpatient colonoscopies performed in the United States, these procedures should be provided with caution to patients with chronic and multiple comorbidities and the elderly, because these populations are associated with higher rates of colonic perforations and GI bleeding.

1 Department of Health Behavior and Policy School of Medicine, Virginia Commonwealth University, Richmond, Virginia

2 Population Sciences, University of Colorado Comprehensive Cancer Center, Department of Health Systems, Management, and Policy, School of Public Health Aurora, Colorado

3 Advanced Therapeutic Endoscopy, Division of Gastroenterology, School of Medicine, Virginia Commonwealth University, Richmond, Virginia

Funding/Support: The VCU Massey Cancer Center pilot grant (CA016059) was used to purchase the Healthcare Cost and Utilization Project’s (HCUP) data sets for this study. Services in support of the research project were generated by the VCU Massey Cancer Center Biostatistics Shared Resource, supported, in part, with funding from NIH-NCI Cancer Center Support grant P30 CA016059.

Financial Disclosures: None reported.

Correspondence: Askar Chukmaitov, M.D., Ph.D., Department of Health Behavior and Research, P.O. Box 980430, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298-0430. E-mail:

© 2016 The American Society of Colon and Rectal Surgeons