A 5-Year Statewide Analysis of Unplanned Hospital Visits for EGD, Colonoscopy, Combined EGD/Colonoscopy, and ERCP

Background and Aims Conventional complication rates for gastrointestinal endoscopic procedures may underestimate the broader risk represented by post-procedure unplanned hospital visits (UHVs). We aimed to characterize UHVs for procedures in Maryland and the District of Columbia from 2014-2018. Methods Data for all EGDs, colonoscopies, combined EGDs/colonoscopies, and ERCPs performed between 2014-2018 was provided by the Maryland Health Information Exchange (CRISP). Patient demographics, timing of UHV within 14 days post-procedure, distance traveled, facility site (“home” vs. “away” institution), and ICD codes for the UHV were analyzed. Only UHVs potentially attributable to the endoscopic procedures were included. Results Among 304,786 endoscopic procedures and 3,904 unplanned visits, the 14-day UHV rates were 1.7%, 0.6%, 1.3%, and 5.2% for EGD, colonoscopy, combined EGD/colonoscopy, and ERCP procedures respectively. From 2014-2018, the UHV rate on an annual basis remained stable for all procedure types except for ERCPs which increased. Patients who experienced UHVs were statistically different in sex, race, age, and distance traveled. UHVs most often occurred on post-procedure day 1; emergency department visits occurred most commonly. UHVs for all procedures, except ERCPs, were more likely to occur at a “home” institution. Overall, patients were more likely to be admitted post-procedure at an “away” institution. Conclusion Post-endoscopic procedure UHV rates were generally low. However, UHV rates for EGDs and colonoscopies were significantly higher than conventional complication rates. As 30-60% of all unplanned visits occurred at an “away” institution, endoscopists should consider a broad approach to detecting post-procedure complications and not rely on a single institution for data capture.