Patients aged 75 years and older appeared to have a higher risk of post-colonoscopy complications during the 30-day period after colonoscopy compared with screen-eligible patients and the decision to perform colonoscopy should be considered carefully in older patients, particularly in the presence of comorbidities, according to researchers from University of Toronto, Toronto and McMaster University, Hamilton, Ontario, Canada.
The paper, ‘Association Between Age and Complications After Outpatient Colonoscopy’, published in JAMA Network, sought to assess whether individuals aged 75 years and older at a higher risk of 30-day post-colonoscopy complications, compared with those aged 50 to 74 years. Specifically, the researchers examined the incidence and independent risk factors of post-colonoscopy complications among adult patients undergoing colonoscopy. They also looked at the risk-benefit ratio by contrasting the incidence of complications and surgically treated colorectal cancers.
This population-based retrospective cohort study included 38,069 adults (≥50 years) undergoing outpatient colonoscopy between April 2008 and September 2017 (patients with inflammatory bowel disease and hereditary colorectal cancer syndromes were excluded). The study population was subdivided into a colorectal cancer screening–eligible cohort (patients aged 50-74 years) and an older cohort (patients aged ≥75 years).
Of the 38,069 patients, 19 037 were female (50.0%) and 27 831 patients (73.1%) underwent a first colonoscopy. The cumulative incidence of complications was 3.4% (1,310 patients) in the overall population, and it was higher in individuals aged 75 years or older (515 of 7,627 patients (6.8%)) than in screening-eligible cohort (795 of 30,443 patients (2.6%, p<1.001)).
Independent risk factors for post-colonoscopy complications were age 75 years or older, anaemia, cardiac arrhythmia, congestive heart failure, hypertension, chronic kidney disease, liver disease, smoking history and obesity. The number of previous colonoscopies was associated with a lower risk of complications. The incidence of surgically treated colorectal cancer was higher in the older cohort than the screening-eligible cohort (119 patients (1.6%) vs 144 patients (0.5%); p<0.001). All-cause mortality rates were 0.1% overall (39 patients) and 0.1% (19 patients) for individuals aged 50 to 74 years and 0.2% (20 patients) for those aged 75 years and older (p<0.001).
In total, 263 patients (0.7%) underwent surgery for colorectal cancer in the 30 days after colonoscopy. The proportion of patients who had surgery was significantly higher after a first-time colonoscopy, compared with surveillance colonoscopy (219 (0.8%) vs 44 (0.4%); p<0.001). IN a comparison in age cohorts, a greater proportion of older patients underwent surgery at 30 days (119 (1.6%) vs 144 (0.5%); p<0.001).
“Baseline comorbidities were independently associated with complications, and cardiovascular-related diagnoses were among the most common causes of hospital admission in the older cohort,” the authors concluded. “In accordance with our findings, the decision to perform colonoscopy should be considered carefully in older patients, particularly in the presence of comorbidities.”
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