Deep Sedation Used in 8.7% of Routine Colonoscopies

Use of anesthesia assistance — defined as administration of propofol by a CRNA or anesthesiologist — varies significantly by region across the United States for routine colonoscopy and is not associated with lower complication rates or higher polyp detection rates for the 8.7% of these procedures it's used in, according to an article in Gastroenterology.

The researchers examined a 20% sample of Medicare administrative claims from the 2003 calendar year and analyzed data from 328,177 adults, 66 years or older who underwent outpatient colonoscopy examinations, to determine whether anesthesia assistance was associated with colonoscopy interventions and outcomes.

Factors predicting the use of anesthesia assistance included black race, female sex, a nonscreening indication for the procedure and non-hospital site of service. Anesthesia assistance also increased with the patient's median income and presence of comorbidities. The strongest indicator was by region and Medicare carrier. "The lowest rates of use were in Montana (0.1%) and South Dakota (0.2%); the highest were in New Jersey (48.1%), New York (27.9%), and Nevada (26.0%)," according to further analysis.

Physician attributes mattered, too: General and colorectal surgeons and endoscopists with fewer years in their practice were significantly associated with increased use of anesthesia assistance. Further, assistance was highly concentrated: 75% of providers performed no colonoscopies with anesthesia assistance, and 4.5% of providers had anesthesia assistance in at least three-quarters of their examinations.

According to the published analysis, "Use of anesthesia assistance didn't alter the rate of detection of colonic polyps or the rate of complications such as GI bleeding, perforation, and hospital/ED visits within 30 days."

Stephanie Wasek