Unplanned ED Visits and Hospitalizations Related to Outpatient Endoscopy

Gastrointestinal (GI) endoscopic procedures are performed at a rate of 15 million to 20 million per year in the United States. However, comprehensive data on the safety and complications from the procedure are limited; studies have utilized inconsistent methods and follow-up periods, and have included physician reporting and telephone follow-up interviews—methods that have limitations. Researchers recently designed a prospective study using an automated system to record visits to emergency departments (EDs) within 14 days of endoscopic procedures. They reported results of the study in Archives of Internal Medicine [2010; 170(19):1752-1757]. Study results included data on the incidence and costs of ED visits related to complications from outpatient endoscopy. The Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts, utilizes an electronic medical record (EMR) system that includes all clinician notes, laboratory data, results of diagnostic tests performed at the facility, and visits to the ED, allowing for precise monitoring of patient outcomes. The EMR is used by all gastroenterologists affiliated with BIDMC, regardless of whether the office visit or endoscopy is performed onsite, at a satellite office, or at a free-standing ambulatory procedure unit. The current analysis involved manually reviewing and evaluating the data gathered by the EMR system to calculate the frequency of ED visits and hospitalizations resulting from GI endoscopic procedures and to estimate the cost of hospital visits resulting from GI endoscopic procedures. The analysis included data on 6383 outpatient esophagogastroduodenoscopies (EGDs) and 11,632 outpatient colonoscopies (7392 of which were performed for colorectal cancer screening or surveillance) performed by staff gastroenterologists and surgeons. Mean age of patients undergoing colonoscopy was 58.0 years; 46.8% were male; mean age of patients undergoing EGD was 55.9 years and 45.1% were male. Fellows in training participated in 6.6% of EGDs and 17.2% of colonoscopies. Within 14 days of the procedure, there were 419 patients seen in the ED and 266 hospitalizations; 32.0% (n=134) of the visits were considered by the physician reviews to be related to the endoscopic procedure and 76 of those resulted in hospitalization. Procedure-related hospital visits occurred in 0.79% (95% confidence interval [CI], 0.63%-0.88%) of all endoscopic procedures, 1.07% (95% CI, 0.84%-1.35%) of all EGDs, 0.84% (95% CI, 0.69%-1.03%) of all colonoscopies, and 0.95% (95% CI, 0.75%-1.19%) of screening colonoscopies. The researchers noted that the hospital visit rate is slightly less for the overall group because an individual patient could be counted only once for this group, whereas an individual who underwent an EGD and a screening colonoscopy could be counted separately for each procedure type. Mean costs per ED visit were $1403; per hospitalization, the mean costs were $10,123, based on Medicare standardized rates. The ED visits and hospitalizations added $48.09 (95% CI, $34.08-$62.10) per examination to the overall screening/surveillance colonoscopy program. The researchers attributed $1,029,624.81 in total costs to unplanned hospital visits related to endoscopic procedures during the 9-month study period. In conclusion, the researchers said they observed a “1% incidence of related hospital visits within 14 days of outpatient endoscopy, 2- to 3-fold higher than recent estimates. Most events were not captured by standard reporting, and strategies for automating adverse event reporting should be developed. The cost of unexpected hospital visits postendoscopy may be significant and should be taken into account in screening or surveillance programs.”