Dataset Information

Association Between Age and Complications After Outpatient Colonoscopy.

ABSTRACT:

Importance

There are insufficient data describing the incidence and risk factors of postcolonoscopy complications in older individuals.

Objective

To assess the association between older age (?75 years) and the risk of postcolonoscopy complications.

Design, setting, and participants

This population-based retrospective cohort study included adults (?50 years) undergoing outpatient colonoscopy between April 2008 and September 2017, identified from Ontario administrative databases. Individuals with inflammatory bowel disease and hereditary colorectal cancer syndromes were excluded. The study population was subdivided into a colorectal cancer screening-eligible cohort (patients aged 50-74 years) and an older cohort (patients aged ?75 years). The statistical analysis was conducted from December 2018 to September 2019.

Exposures

Older age (?75 years).

Main outcomes and measures

The primary outcome was postcolonoscopy complications, defined as the composite of hospitalization or emergency department visits in the 30-day period after the outpatient colonoscopy. Secondary outcomes included incidence of surgically treated colorectal cancer and all-cause mortality at 30 days. Independent variables associated with postcolonoscopy complications were also assessed.

Results

The study sample included 38?069 patients; the mean (SD) age was 65.2 (10.1) years, there were 19?037 women (50.0%), and 27?831 patients (73.1%) underwent a first colonoscopy. The cumulative incidence of complications was 3.4% (1310 patients) in the overall population, and it was higher in individuals aged 75 years or older (515 of 7627 patients [6.8%]) than in screening-eligible cohort (795 of 30?443 patients [2.6%]) (P?Conclusions and relevanceIn this population-based cohort study of individuals living in southern Ontario, age of 75 years and older was associated with a higher risk of 30-day postprocedure complications after outpatient colonoscopy. These findings suggest that the decision to perform a colonoscopy should be carefully considered in patients older than 75 years, especially in the presence of comorbidities. Further studies are needed to better understand the benefits of invasive procedures as opposed to less invasive approaches for colorectal cancer screening and surveillance among older patients.

SUBMITTER: Causada-Calo N

PROVIDER: S-EPMC7317606 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Association Between Age and Complications After Outpatient Colonoscopy.

Causada-Calo Natalia N Bishay Kirles K Albashir Siwar S Al Mazroui Ahmed A Armstrong David D

JAMA network open 20200601 6

<h4>Importance</h4>There are insufficient data describing the incidence and risk factors of postcolonoscopy complications in older individuals.<h4>Objective</h4>To assess the association between older age (≥75 years) and the risk of postcolonoscopy complications.<h4>Design, setting, and participants</h4>This population-based retrospective cohort study included adults (≥50 years) undergoing outpatient colonoscopy between April 2008 and September 2017, identified from Ontario administrative databa ...[more]

PMID: 32584409

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Project description:BackgroundTo what extent the risk for colorectal cancer (CRC) death among noncompliers of colonoscopy is elevated following positive fecal immunological testing and whether the elevated risk varies with the fecal hemoglobin concentration (f-Hb) and location of CRC have not been researched.MethodsWe used data on 59 389 individuals (4.0%) among 1 489 937 Taiwanese screenees age 50 to 69 years with f-Hb 20??g hemoglobin or more per gram of feces from 2004 to 2009. They were classified into 41 995 who received colonoscopy and 10 778 who received no confirmatory examination; the latter was categorized into three risk groups according to f-Hb (20-49, 50-99, and 100+). Mortality from CRC as the primary end point was monitored until December 31, 2012.ResultsA 1.64-fold (95% confidence interval [CI] = 1.32 to 2.04) increased risk for CRC death for the noncolonoscopy group as opposed to the colonoscopy group adjusting for differences in baseline characteristics. A gradient relationship was noted between cumulative mortality and age- and sex-adjusted f-Hb categories with 1.31-fold (95% CI?=?1.04 to 1.71), 2.21-fold (95% CI?=?1.55 to 3.34), and 2.53-fold (95% CI?=?1.95 to 3.43) increased risk, respectively, for the 20-49, 50-99, and 100+ risk groups in the noncolonoscopy group compared with the colonoscopy group. The noncolonoscopy group led to a statistically significant 1.75-fold increased risk (95% CI?=?1.35 to 2.33) for CRC of the distal colon but a statistically nonsignificant 1.11-fold increased risk (95% CI?=?0.70 to 1.75) for the proximal colon, compared with the colonoscopy group. When the comparator was limited to subjects whose colonoscopy was completed to the cecum, the statistically significantly elevated risk for CRC mortality was seen for both distal and proximal colon in the noncolonoscopy group.ConclusionsAfter a positive fecal immunochemical test, colonoscopy can reduce by about half the number of deaths from CRC. Among colonoscopy noncompliers, higher f-Hb is associated with an increased risk of mortality from CRC in a dose-response manner.

Dataset Information

Association Between Age and Complications After Outpatient Colonoscopy.

Importance

Objective

Design, setting, and participants

Exposures

Main outcomes and measures

Results

Publications

Association Between Age and Complications After Outpatient Colonoscopy.

Similar Datasets

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