Complication rates of colonoscopy in an Australian teaching hospital environment

• Published in: Internal medicine journal Vol. 33; no. 8; pp. 355 - 359
• Main Authors: Viiala, C. H., Zimmerman, M., Cullen, D. J. E., Hoffman, N. E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Pty 01-08-2003; Blackwell Science
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Care; Biological and medical sciences; Colon - injuries; colonoscopy; Colonoscopy - adverse effects; Colonoscopy - mortality; complications; Digestive system. Abdomen; Endoscopy; Female; Gastrointestinal Hemorrhage - etiology; Hospitals, Teaching; Humans; Intestinal Perforation - etiology; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Professional Competence; Quality Assurance, Health Care; quality ­assurance; Western Australia - epidemiology; Australia; Oceania; Western Australia; Human; Quality assurance; Teaching hospital; Prevalence; Colonoscopy; Environment impact; Complication; Endoscopy
• ISSN: 1444-0903; 1445-5994
• DOI: 10.1046/j.1445-5994.2003.00397.x

Background:  Quality assurance is an important part of health‐care delivery. With the high level of awareness relating to adverse events from medical care, demonstration of a high standard of practice in gastroenterology is desirable.
Aims:  To determine the incidence of significant complications or death within 30 days of an outpatient colonoscopy, and confirm that these are in keeping with international standards.
Methods:  A retrospective audit of linked endoscopy and other hospital databases and selected medical records was carried out, based on reports of 30 463 colon­oscopies performed between 5 September 1989 and 31 December 1999 in the three Western Australian public teaching hospitals.
Results:  A total of 23 508 colonoscopies was performed on an outpatient basis between 5 September 1989 and 31 December 1999. Post‐procedural complications identified (and incidence) were: bleeding episodes 49 (0.21%), colonic perforation 23 (0.1%), abdominal pain 22 (0.09%), and others 19 (0.08%). A total of 196 patients died within 30 days of undergoing colonoscopy (0.83%), although only three deaths were attributable to the procedure itself (incidence 0.01%). Two were inpatients at the time of the procedure (outpatient mortality rate 0.004%). The combined incidence of bleeding and perforation was not significantly different between consultant endoscopists and unassisted trainees (incidence 0.21% vs 0.20%, P = 0.98).
Conclusions:  The incidence of bleeding and perforation is similar to other reported series and reflects procedures performed by personnel with a wide range of endoscopic experience. The incidence of complications was not greater for trainees compared with consultant endoscopists. All bleeding episodes and the majority of per­forations were associated with a therapeutic intervention. Diagnostic colonoscopy in particular is a very safe procedure. (Intern Med J 2003; 33: 355−359)