1 Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina (UNC) Health Care, Chapel Hill, NC, United States.
2 Department of Anesthesiology, University of North Carolina (UNC) Health Care, Chapel Hill, NC, United States
BACKGROUND & AIMS: Anesthesia services for endoscopic procedures have proliferated with the promise of increased comfort and safety. Cirrhosis patients are higher risk for sedation, yet limited data are available describing anesthesia complications in this population.
APPROACH & RESULTS: This cross-sectional study utilized the National Anesthesia Clinical Outcomes Registry, a multi-center quality improvement database from 2010 to 2015. Cirrhosis patients undergoing an endoscopy were identified by ICD 9/CPT codes. The outcome of interest was serious anesthesia-related complication defined as cardiovascular, respiratory, neurologic, drug-related, patient injury, death, or unexpected admission. A mixed effects multivariate logistic regression model determined odds ratios between variables and serious complications adjusting for potential confounders. In total, 9,007 endoscopic procedures were performed among cirrhosis patients; 92% were esophagogastroduodenoscopies. A majority (81%) were American Society of Anesthesiologists (ASA) class >=3 and 72% had a history of hepatic encephalopathy, ascites, varices, hepatorenal syndrome, or spontaneous bacterial peritonitis identified by ICD-9/CPT codes. In total, 87 complications were reported, 33 of which were serious. The frequency of serious complications was 0.4% or 378.6 per 100,000 procedures (95% CI 260.8, 531.3). A majority of serious complications were cardiovascular (21/33) including 15 cardiac arrests. Serious complications were significantly associated with ASA4/5 (OR 3.84; 95% CI 1.09, 13.57) and general anesthesia (OR 4.71; 95% CI 1.20, 18.50) adjusting for age, sex, ASA class, anesthesia type, inpatient status, portal hypertension history, and variable complication reporting practices.
CONCLUSIONS: Anesthesia complications among endoscopic procedures in cirrhosis are rare overall. Serious complications were predominantly cardiac and associated with sicker patients undergoing general anesthesia. The complexity of end stage liver disease may warrant more intensive care during endoscopic procedures including anesthesia monitoring.