Routine capnographic monitoring used in high-volume colonoscopy procedures with moderate sedation increased cost significantly, but did not improve patient safety or satisfaction in a recent case-controlled observational study.
Daniel A. Leffler, MD, from the department of gastroenterology at Beth Israel Deaconess Medical Center in Boston, and colleagues evaluated the safety of sedation and patient satisfaction with capnographic monitoring in 966 patients undergoing outpatient colonoscopy procedures.
Daniel A. Leffler
They examined complications of sedation and used the validated Procedural Sedation Assessment Survey (PROSAS) to determine patient satisfaction. The findings were compared in one group of patients that underwent routine colonoscopy before capnographic monitoring was introduced (pre-capnography group; n = 465) and a group of patients examined after capnographic monitoring was introduced (capnography group; n = 501).
There were no serious adverse events reported in either group.
“The low adverse event rate during routine colonoscopy in our study is not surprising, as we routinely refer higher-risk patients to receive deep sedation with an anesthesiologist,” the researchers wrote.
Patients and nurses reported more procedural discomfort experienced in the capnography group compared with the pre-capnography group (1.71 vs. 1; P < .001). Also, there was no significant difference found between groups in the occurrence of minor sedation-related adverse events (8.2% in the pre-capnography group vs. 11.2% in the capnography group; P = .115).
The addition of capnography to routine colonoscopy with moderate sedation increased the cost by $11.68 per procedure, a total of $40,169.95 for all procedures, which did not include the original investment in capnography monitors.
“The addition of capnography during adult routine colonoscopy under moderate sedation did not improve quality or safety but was associated with significant cost,” the researchers concluded. “These results do not support the use of [capnography] in routine outpatient colonoscopy with moderate sedation, and further studies are needed to better elucidate subpopulations in endoscopy, which may benefit from [capnographic] monitoring.” – by Suzanne Reist
Disclosure: The researchers report no relevant financial disclosures.