Original articleAlimentary tractRisk Factors for Early Colonoscopic Perforation Include Non-Gastroenterologist Endoscopists: A Multivariable Analysis
Section snippets
Database
This study analyzed prospectively collected data from the Clinical Outcomes Research Initiative (CORI) National Endoscopic Database, a large North American database consisting of diverse practice types. Participating physicians are provided with an electronic health record that is completed at the time of endoscopy and generates procedure reports used for recordkeeping as part of the official medical record. Users are required to document at least 95% of procedures in CORI. Once signed off,
Results
Between January 2000 and March 2011, 192 perforation events were recorded in 1,144,900 adult colonoscopies entered into the CORI database, corresponding to an early perforation rate of 0.017% or 1 in 5882 procedures. Characteristics of the study patients along with the incidence of early colonoscopy-related perforation and univariate analysis appear in Table 1.
On univariate analysis, significantly higher rates of early perforation were observed with increasing patient age and ASA class, as well
Discussion
Previous studies of perforation risk factors in colonoscopy have suggested that gastroenterologists may cause fewer perforations than surgeon endoscopists, but these differences were never shown to be significant.2, 21 The current study revealed significantly increased early perforation risk in colonoscopies performed by surgeon endoscopists when controlling for other variables. This suggests there is a difference in quality between procedures performed by gastroenterologists and
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Conflicts of interest This author discloses the following: Dr Lieberman is the executive director of CORI, a nonprofit organization that receives funding from federal and industry sources. This potential conflict of interest has been reviewed and managed by the OHSU and Portland VA Conflict of Interest in Research Committees. The remaining authors disclose no conflicts.
Funding This project was supported with funding from NIDDK U01DK57132, R33-DK61778-01, and R21-CA131626. In addition, the practice network (Clinical Outcomes Research Initiative) has received support from the following entities to support the infrastructure of the practice-based network: AstraZeneca, Novartis, Bard International, Pentax USA, ProVation, Endosoft, GIVEN Imaging, and Ethicon. The commercial entities had no involvement in this research.