Prospective analysis of negative outcomes 30 days after outpatient colonoscopy

Prior work by our group found that contacting patients 30 days after outpatient procedures detected a greater number of negative outcomes (complications) than those detected at our monthly Quality Assurance meetings. Our objectives were to analyze the nature of negative outcomes after outpatient colonoscopy at 30 day follow-up, and to see if there are any risk factors that can predict these negative outcomes. Methods: Trained interviewers performed standardized telephone interviews on consecutive patients undergoing outpatient colonoscopy in our unit over a 6 month period. Patients were queried regarding potential events related to their colonoscopy in the thirty days subsequent, including unanticipated symptoms, physician/ER visits and hospitalizations. The indications, findings and therapies performed during the procedures were then reviewed from endoscopic reports. Results: 514 patients were contacted 30 days after their outpatient colonoscopy. The average age of those undergoing colonoscopy was 57.6, and 47.39; were female. 98 patients (19.1%) had a negative outcome at 30 days. 15 patients (2.9%) required physician/ER visits, and 7 patients (1.4%) required hospitalization. The most common negative outcomes reported by patients were abdominal pain (36 patients), rectal bleeding (16 patients), fatigue (9 patients) and gas (9 patients). The most common negative outcome requiring physician/ER visits or hospitalization was rectal bleeding (6/15 and 5/7 respectively). Females were more likely to have negative outcomes at 30 days than males (22.2% vs. 16.2%). 35% of patients undergoing combined EGD/colonoscopy had negative outcomes at 30 days versus 17.3% of patients undergoing colonoscopy alone. Rectal bleeding as an indication for colonoscopy resulted in the most negative outcomes at 30 days (24). 57% of patients requiring hospitalization had removal of a polyp by snare polypectomy (4/7), all of these patients (4/4) had polyps at least 10mm in size. Conclusions: 19.1% of our patients reported a negative outcome on 30 day follow-up after outpatient colonoscopy. The most common negative outcome after colonoscopy was abdominal pain, but the most common negative outcome resulting in a physician/ER visit or hospitalization was rectal bleeding. Females, patients undergoing combined EGD/colonoscopy, and those with rectal bleeding as an indication for colonoscopy were at higher risk for a negative outcome at 30 days.