Outpatient facility volume, facility type, and the risk of serious colonoscopy-related adverse events in patients with comorbid conditions: a population-based study
- 15 Downloads
Patients with a chronic comorbidity or multiple comorbidities are at much greater risk of serious colonoscopy-related gastrointestinal (GI) adverse events relative to patients with no comorbidity. It is important to identify outpatient facilities that can effectively and safely provide colonoscopy to complex patients. To address this need, the association between outpatient facilities’ complex care volume and type (ambulatory surgery center (ASC) and hospital outpatient department (HOPD)) and the risks of serious GI adverse events in colonoscopy patients with single and multiple chronic comorbidities were examined.
Outpatient colonoscopies of 1,020,372 patients with single and multiple comorbidities were investigated, using a retrospective cohort study. Thirty-day hospitalizations due to colonic perforations and GI bleeding were examined. Ambulatory surgery and hospital discharge datasets from California, Florida, and New York for 2006–2009 were used.
Higher complex care volume was associated with lower risks of adverse events in patients with comorbidities (OR 1.69; 95% CI [1.13, 2.54]). ASCs had higher risks of adverse events in patients with comorbidities relative to HOPDs (OR 2.85; 95% CI [2.40, 3.38]). Patients with single and multiple comorbid conditions, patients with systemic diseases, and complex patients of advanced age had higher risks of adverse events.
Referring patients with single and multiple chronic comorbidities to facilities experienced in treating complex patients, or HOPDs, may reduce colonoscopy-related adverse events.
KeywordsOutpatient colonoscopy Chronic comorbid conditions Adverse events Freestanding ambulatory surgery centers Hospital-based outpatient departments
The VCU Massey Cancer Center pilot grant (CA016059) was used to purchase the Healthcare Cost and Utilization Project’s (HCUP) datasets 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.
- 1.American Cancer Society (ACS) (2018) Cancer facts & figures. Retrieved August 2018, from https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2018/cancer-facts-and-figures-2018.pdf
- 3.Center for Disease Control and Prevention (CDC) (2016) Colorectal cancer screening capacity in the U.S. Retrieved August 2018, from https://www.cdc.gov/cancer/dcpc/research/articles/crc_screening_model.htm
- 8.Chukmaitov AS, Menachemi N, Brown LS, Saunders C, Brooks RG (2008b) A comparative study of quality outcomes in freestanding ambulatory surgery centers and hospital-based outpatient departments: 1997-2004. Health Serv Res 43(5 Pt 1):1485–1504Google Scholar
- 10.Ranasinghe I, Parzynski CS, Searfoss R, Montague J, Lin Z, Allen J, Vender R, Bhat K, Ross JS, Bernheim S, Krumholz HM, Drye EE (2016) Differences in colonoscopy quality among facilities: development of a post-colonoscopy risk-standardized rate of unplanned hospital visits. Gastroenterology. 150(1):103–113CrossRefGoogle Scholar
- 17.Watabe H, Yamaji Y, Okamoto M, Kondo S, Ohta M, Ikenoue T, Kato J, Togo G, Matsumura M, Yoshida H, Kawabe T, Omata M (2006) Risk assessment for delayed hemorrhagic complication of colonic polypectomy: polyp-related factors and patient-related factors. Gastrointest Endosc 64(1):73–78CrossRefGoogle Scholar
- 20.Centers for Medicare and Medicaid Services (CMS) (2015) CMS proposes hospital outpatient and ambulatory surgical center policy and payment changes, including proposed changes to the two-midnight rule, and quality reporting changes for 2016. Retrieved in June 2018, from https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-07-01.html
- 21.Medicare Payment Advisory Commission (MedPAC) (2017) Report to the congress: Medicare payment policy. Ambulatory surgical center services. Retrieved in June 2018, from http://www.medpac.gov/docs/default-source/reports/mar17_entirereport.pdf