The rates of infections after endoscopic procedures performed at ambulatory surgical centers in the U.S. are far higher than previously thought, according to Johns Hopkins researchers.
Their new study published in Gut indicates that at some of these outpatient sites, the risk for post-procedural infection can be up to 100 times higher than expected.
In a press release, Susan Hutfless, MD, of the division of gastroenterology and hepatology, and the Gastrointestinal Epidemiology Research Center at Johns Hopkins University, said that infections were thought to occur after about one in a million endoscopic procedures, but the rate is actually slightly higher than 1 in a thousand for screening colonoscopy, about 1.6 in a thousand for non-screening colonoscopy, and more than 3 in a thousand for esophagogastroduodenoscopy (EGD).
“Though patients are routinely told that common endoscopic procedures are safe, we found that post-endoscopic infections are more common than we thought, and that they vary widely from one ASC facility to another,” Hutfless said in the press release.
She and colleagues estimated post-endoscopy infection rates by analyzing all-payer claims data on infection-related emergency department visits and unplanned inpatient admissions occurring within one week to a month after an endoscopic procedure.
In addition to the significantly higher than expected infection rates mentioned above, they also found that patients who were hospitalized within 30 days before an endoscopic procedure showed an even higher risk for infection, with nearly 45 in a thousand hospitalized for an infection within a month after a screening colonoscopy, and more than 59 in a thousand hospitalized for an infection after EGD. Further, their data suggested that infection rates were slightly higher for diagnostic vs. screening procedures.
They also found that infections within a week of endoscopy varied widely across ASCs, ranging from 0 to 115 in a thousand screening colonoscopies, 0 to 132 in a thousand non-screening colonoscopies and 0 to 62 in a thousand EGDs. High-volume centers showed lower rates of post-endoscopic infections.
Hutfless noted in the press release that many ASCs do not have hospital-linked electronic medical record systems and are therefore less aware of the number of their patients who develop infections after an endoscopic procedure.
“If they don’t know their patients are developing these serious infections, they’re not motivated to improve their infection control,” she said in the press release.
She and colleagues concluded that patients should be informed of the infection risks associated with endoscopic procedures, and that “patient-accessible public reporting of facility-level procedure volumes and infection rates may be valuable to patients seeking quality of care information.” – by Adam Leitenberger
Disclosures: The authors report no relevant financial disclosures.